Provider Demographics
NPI:1508259581
Name:WELBORN, MARNETA (LCPC)
Entity type:Individual
Prefix:
First Name:MARNETA
Middle Name:
Last Name:WELBORN
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 STAMPEDE AVE # 200
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4818
Mailing Address - Country:US
Mailing Address - Phone:307-899-1538
Mailing Address - Fax:
Practice Address - Street 1:1701 STAMPEDE AVE # 200
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4818
Practice Address - Country:US
Practice Address - Phone:307-899-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT39017101YM0800X, 101YM0800X
WYCAP143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)