1881260834 NPI number — MARILYNN WEISBACH SPENCE

Table of content: PALOMA AURORA ESPINOZA QMHC (NPI 1063966349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881260834 NPI number — MARILYNN WEISBACH SPENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCE
Provider First Name:
MARILYNN
Provider Middle Name:
WEISBACH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEISBACH
Provider Other First Name:
MARILYNN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881260834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 W RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-6454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-792-1642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 W RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-6454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
187-921-6423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1948 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)