Provider Demographics
NPI:1609942465
Name:NOLAN, MARILYN JEANETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JEANETTE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2401 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9065
Mailing Address - Country:US
Mailing Address - Phone:417-782-7700
Mailing Address - Fax:417-782-6760
Practice Address - Street 1:2401 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9065
Practice Address - Country:US
Practice Address - Phone:417-782-7700
Practice Address - Fax:417-782-6760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 000769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional