Provider Demographics
NPI:1497768022
Name:MACON-STRONG, MARILYN D (LPC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:D
Last Name:MACON-STRONG
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 5637
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-5637
Mailing Address - Country:US
Mailing Address - Phone:903-831-7585
Mailing Address - Fax:903-831-4823
Practice Address - Street 1:1825 N ROBISON RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4180
Practice Address - Country:US
Practice Address - Phone:903-831-7585
Practice Address - Fax:903-831-4823
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82535LOtherBCBS PROVIDER NUMBER