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General NPI Number Information
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NPI Number | 1346632007
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Entity Type | Individual
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Provider Name | JOELLEN MARIE MARION APRN PMHNP-BC LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 719 DISHMAN LANE EXT APT C
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4072
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Country | US
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Telephone | 270-202-8669
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Fax | 270-200-8781
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Provider Business Mailing Address
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Address Line | 719 DISHMAN LANE EXT APT C
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4072
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Country | US
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Telephone | 270-202-8669
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Fax | 270-200-8781
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 174708
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301015869
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4030407
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License Number State | KY
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