Provider Demographics
NPI:1750682993
Name:KING, MARNIE K (PLMHP)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:K
Last Name:KING
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3377
Mailing Address - Country:US
Mailing Address - Phone:402-331-3232
Mailing Address - Fax:402-331-1557
Practice Address - Street 1:8610 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3377
Practice Address - Country:US
Practice Address - Phone:402-331-3232
Practice Address - Fax:402-331-1557
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025057600Medicaid
NE47083066228Medicaid