Provider Demographics
NPI:1881717726
Name:RICHARDSON, MARLENE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-2231
Mailing Address - Country:US
Mailing Address - Phone:503-979-4655
Mailing Address - Fax:503-767-3052
Practice Address - Street 1:377 WEST WATER ST
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-4018
Practice Address - Country:US
Practice Address - Phone:503-979-4655
Practice Address - Fax:503-967-3052
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional