Provider Demographics
NPI:1881260834
Name:SPENCE, MARILYNN WEISBACH
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:WEISBACH
Last Name:SPENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYNN
Other - Middle Name:KAY
Other - Last Name:WEISBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:148 W RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6454
Mailing Address - Country:US
Mailing Address - Phone:318-792-1642
Mailing Address - Fax:
Practice Address - Street 1:148 W RIDGE DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6454
Practice Address - Country:US
Practice Address - Phone:187-921-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional