Provider Demographics
NPI:1336271345
Name:LAMAR, MARLYS CAMILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLYS
Middle Name:CAMILLE
Last Name:LAMAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6072
Mailing Address - Country:US
Mailing Address - Phone:940-566-5802
Mailing Address - Fax:940-343-1030
Practice Address - Street 1:416 S ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6072
Practice Address - Country:US
Practice Address - Phone:940-566-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23460103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097520302Medicaid
TX00B50AMedicare ID - Type Unspecified
TX097520302Medicaid