Provider Demographics
NPI:1144364316
Name:PIPER, MARCUS A (MS, LCPC)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:A
Last Name:PIPER
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4927
Mailing Address - Country:US
Mailing Address - Phone:618-210-2039
Mailing Address - Fax:618-288-0737
Practice Address - Street 1:20 PROFESSIONAL PARK DR # A
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5669
Practice Address - Country:US
Practice Address - Phone:618-210-2039
Practice Address - Fax:618-288-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional