Provider Demographics
NPI:1649634106
Name:MARQUIS, PHILIPPE RENE (MA, LPC)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:RENE
Last Name:MARQUIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEB 3377
Mailing Address - Street 2:
Mailing Address - City:LANDSTUHL
Mailing Address - State:GEB 3377, 66849 LANDSTUHL, GERMANY
Mailing Address - Zip Code:66849
Mailing Address - Country:DE
Mailing Address - Phone:063719-464-5762
Mailing Address - Fax:
Practice Address - Street 1:3225 S WADSWORTH BLVD
Practice Address - Street 2:UNIT T
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5019
Practice Address - Country:US
Practice Address - Phone:303-231-0090
Practice Address - Fax:303-231-0992
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health