Provider Demographics
NPI:1265768337
Name:MARR, NATALIE MARIE (LP)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MARIE
Last Name:MARR
Suffix:
Gender:F
Credentials:LP
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 490171
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-0171
Mailing Address - Country:US
Mailing Address - Phone:1763-762-6988
Mailing Address - Fax:
Practice Address - Street 1:6121 EXCELSIOR BLVD
Practice Address - Street 2:STE 101A
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2752
Practice Address - Country:US
Practice Address - Phone:612-440-8742
Practice Address - Fax:716-531-9060
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical