Provider Demographics
NPI:1346958782
Name:HAIZLIP, MARCIA BETH (LPC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:BETH
Last Name:HAIZLIP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-1134
Mailing Address - Country:US
Mailing Address - Phone:870-625-0273
Mailing Address - Fax:870-625-0275
Practice Address - Street 1:1355 TATE AVE
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-8064
Practice Address - Country:US
Practice Address - Phone:870-625-0273
Practice Address - Fax:870-625-0275
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9307017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health