Provider Demographics
NPI:1942292636
Name:STARK, MARILYN MARLAINE (LMHC ACAPC LMHP LAPC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MARLAINE
Last Name:STARK
Suffix:
Gender:F
Credentials:LMHC ACAPC LMHP LAPC
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2327 DODGE CT
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-4816
Mailing Address - Country:US
Mailing Address - Phone:402-235-3896
Mailing Address - Fax:
Practice Address - Street 1:515 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4419
Practice Address - Country:US
Practice Address - Phone:712-322-6833
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAACADC97038101YA0400X
IALMHC00258101YM0800X
IALMHP1648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health