Provider Demographics
NPI:1609170323
Name:MARLATT, LORAINE POE (LPC)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:POE
Last Name:MARLATT
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 1:2502 W COLORADO AVE
Mailing Address - Street 2:TEMPLETON BUILDING - SUITE 305
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3023
Mailing Address - Country:US
Mailing Address - Phone:719-640-3817
Mailing Address - Fax:
Practice Address - Street 1:2502 W COLORADO AVE
Practice Address - Street 2:TEMPLETON BUILDING - SUITE 305
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3023
Practice Address - Country:US
Practice Address - Phone:719-640-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health