Healthcare Provider Details

I. General information

NPI: 1144364316
Provider Name (Legal Business Name): MARCUS A. PIPER M.S., L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROFESSIONAL PARK DR # A
MARYVILLE IL
62062-5669
US

IV. Provider business mailing address

3029 IOWA ST
GRANITE CITY IL
62040-4927
US

V. Phone/Fax

Practice location:
  • Phone: 618-210-2039
  • Fax: 618-288-0737
Mailing address:
  • Phone: 618-210-2039
  • Fax: 618-288-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: