Provider Demographics
NPI:1407180219
Name:HENDRICKS, MARIANNE (LPC, LBP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LPC, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:2114 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7254
Practice Address - Country:US
Practice Address - Phone:918-876-4211
Practice Address - Fax:918-876-4215
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170GMedicaid
OK200362830AMedicaid