Provider Demographics
NPI:1457501595
Name:MARINUS, GENE KEITH (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:KEITH
Last Name:MARINUS
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4873 STONECREST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8074
Mailing Address - Country:US
Mailing Address - Phone:479-409-3881
Mailing Address - Fax:
Practice Address - Street 1:6801 ISAACS ORCHARD RD STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6799
Practice Address - Country:US
Practice Address - Phone:479-409-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1106042101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor