Provider Demographics
NPI:1538655873
Name:MARION, PAUL RICHARD (PLPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:MARION
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 MANRESA LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7321
Mailing Address - Country:US
Mailing Address - Phone:314-322-7123
Mailing Address - Fax:
Practice Address - Street 1:835 W TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2300
Practice Address - Country:US
Practice Address - Phone:636-345-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018012835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health