Provider Demographics
NPI:1013464478
Name:HILLSMAN, MARILYN S (LPC, NCC, EMDR)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:S
Last Name:HILLSMAN
Suffix:
Gender:F
Credentials:LPC, NCC, EMDR
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:S
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 NW SOUTH OUTER RD., SUITE 302
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3059
Mailing Address - Country:US
Mailing Address - Phone:660-429-9178
Mailing Address - Fax:877-558-3505
Practice Address - Street 1:1200 NW SOUTH OUTER RD., SUITE 302
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3059
Practice Address - Country:US
Practice Address - Phone:660-429-9178
Practice Address - Fax:877-558-3505
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015005794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013464478Medicaid