Provider Demographics
NPI:1700871225
Name:MARVIN, KRIS EARL (LISW)
Entity type:Individual
Prefix:MR
First Name:KRIS
Middle Name:EARL
Last Name:MARVIN
Suffix:
Gender:M
Credentials:LISW
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 474
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-0474
Mailing Address - Country:US
Mailing Address - Phone:515-532-3338
Mailing Address - Fax:515-532-3339
Practice Address - Street 1:103 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-1430
Practice Address - Country:US
Practice Address - Phone:515-532-3338
Practice Address - Fax:515-532-3339
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA254111OtherCOMPSYCH
IA11472253OtherCAQH
IA230092OtherMIDLANDS CHOICE
IA0486761Medicaid
IA9385519OtherPRIVATE HEALTH CARE
IA112848OtherHEALTH ALLIANCE
IA11472253OtherFIRST HEALTH
IA38640OtherBLUE CROSS BLUE SHIELD
IAI20575Medicare PIN
IA9385519OtherPRIVATE HEALTH CARE