Provider Demographics
NPI:1679681977
Name:MARLAR, MARYANN E (LADAC MFT)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:E
Last Name:MARLAR
Suffix:
Gender:F
Credentials:LADAC MFT
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 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1349
Mailing Address - Country:US
Mailing Address - Phone:505-388-4497
Mailing Address - Fax:505-534-1150
Practice Address - Street 1:315 S HUDSON
Practice Address - Street 2:SUITE 19
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:505-388-4497
Practice Address - Fax:505-534-1150
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0081951101YA0400X
NM0075181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58852531Medicaid