Provider Demographics
NPI:1740641950
Name:MARION, H (LAC)
Entity type:Individual
Prefix:MS
First Name:H
Middle Name:
Last Name:MARION
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793-2 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9744
Mailing Address - Country:US
Mailing Address - Phone:219-759-6760
Mailing Address - Fax:219-759-6289
Practice Address - Street 1:793-2 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-9744
Practice Address - Country:US
Practice Address - Phone:219-759-6760
Practice Address - Fax:219-759-6289
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000046A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)