Provider Demographics
NPI:1417110164
Name:MARRIAGE RESOURCE CENTER
Entity Type:Organization
Organization Name:MARRIAGE RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRIMARY COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:570-878-3375
Mailing Address - Street 1:327 N WASHINGTON AVE
Mailing Address - Street 2:#105
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1549
Mailing Address - Country:US
Mailing Address - Phone:570-878-3375
Mailing Address - Fax:
Practice Address - Street 1:327 N WASHINGTON AVE
Practice Address - Street 2:#105
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1549
Practice Address - Country:US
Practice Address - Phone:570-878-3375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health