Provider Demographics
NPI:1407333818
Name:FEDERSPIEL, MARIANN (LPC)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:FEDERSPIEL
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 1:560 W CANFIELD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7953
Mailing Address - Country:US
Mailing Address - Phone:208-758-7111
Mailing Address - Fax:888-398-4676
Practice Address - Street 1:560 W CANFIELD AVE STE 300
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7953
Practice Address - Country:US
Practice Address - Phone:208-758-7111
Practice Address - Fax:888-398-4676
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty