Provider Demographics
NPI:1720326473
Name:MARION COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:MARION COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-956-4816
Mailing Address - Street 1:PO BOX 13509
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-3509
Mailing Address - Country:US
Mailing Address - Phone:601-956-4816
Mailing Address - Fax:
Practice Address - Street 1:460 BRIARWOOD DR STE 510
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3057
Practice Address - Country:US
Practice Address - Phone:601-956-4816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12 00024395251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01670076Medicaid
MS302G706410OtherMEDICARE