Provider Demographics
NPI:1912678590
Name:MARBLE, DEXTER LEE (LMLP-T)
Entity Type:Individual
Prefix:
First Name:DEXTER
Middle Name:LEE
Last Name:MARBLE
Suffix:
Gender:M
Credentials:LMLP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3333
Mailing Address - Country:US
Mailing Address - Phone:620-251-8180
Mailing Address - Fax:620-251-7400
Practice Address - Street 1:1601 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3333
Practice Address - Country:US
Practice Address - Phone:620-251-8180
Practice Address - Fax:620-251-7400
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03083-T103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist