=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245505395
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARQUEST LINDSEY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2012
-----------------------------------------------------
Last Update Date | 05/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1520 29TH AVE
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39501-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-591-1442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1520 29TH AVE
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39501-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-591-1442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC-23108
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------