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General NPI Number Information
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NPI Number | 1346326501
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Entity Type | Individual
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Provider Name | MARILYN DIANNE MACLIN LPC
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | SOUTH BYPASS AND JACKSON STREET
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City | KENNETT
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State | MO
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Zip | 63851
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Country | US
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Telephone | 573-717-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 708 S 4TH ST
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City | HAYTI
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State | MO
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Zip | 63851-1906
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Country | US
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Telephone | 573-359-0312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002469
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License Number State | MO
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