Provider Demographics
NPI:1982079588
Name:DALLAS, MARSHA LYNNE (MA, LPC, NCC, SCL)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LYNNE
Last Name:DALLAS
Suffix:
Gender:F
Credentials:MA, LPC, NCC, SCL
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:LYNNE
Other - Last Name:ELSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, SCL, NCC
Mailing Address - Street 1:1212 VETERANS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4734
Mailing Address - Country:US
Mailing Address - Phone:231-818-8483
Mailing Address - Fax:
Practice Address - Street 1:1212 VETERANS DR STE 206
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4734
Practice Address - Country:US
Practice Address - Phone:231-818-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC0000459101YS0200X
MIL869068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool