Healthcare Provider Details

I. General information

NPI: 1346632007
Provider Name (Legal Business Name): JOELLEN MARIE MARION APRN PMHNP-BC LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOELLEN MARIE HELDT

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 DISHMAN LANE EXT APT C
BOWLING GREEN KY
42104-4072
US

IV. Provider business mailing address

719 DISHMAN LANE EXT APT C
BOWLING GREEN KY
42104-4072
US

V. Phone/Fax

Practice location:
  • Phone: 270-202-8669
  • Fax: 270-200-8781
Mailing address:
  • Phone: 270-202-8669
  • Fax: 270-200-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number174708
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015869
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4030407
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: