Provider Demographics
NPI:1144612607
Name:BADER-NESSE, MARILYN THERESA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:THERESA
Last Name:BADER-NESSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5324
Mailing Address - Country:US
Mailing Address - Phone:360-647-8877
Mailing Address - Fax:
Practice Address - Street 1:435 MARTIN ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4118
Practice Address - Country:US
Practice Address - Phone:360-990-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60161215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health