Provider Demographics
NPI:1255621652
Name:MARLATT, STEPHANIE LYN (BSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYN
Last Name:MARLATT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 N BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5204
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:479-387-6274
Practice Address - Street 1:3715 N BUSINESS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5204
Practice Address - Country:US
Practice Address - Phone:479-575-9471
Practice Address - Fax:479-387-6274
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR913472017101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor