MEDICARE: MS. ELLEN HARRIS MARMON MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC005788	GA

General Provider Information

NPI Number	:	1255547469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN HARRIS MARMON MS, LPC

Provider Business Mailing Address
First Line	:	2964 PEACHTREE RD NW
Second Line	:	SUITE 620
City	:	ATLANTA
State	:	GA
Zip	:	30305-2153
Country	:	US
Telephone Number	:	404-219-1679
Fax Number	:	404-521-4709

Provider Business Practice Location Address
First Line	:	2964 PEACHTREE RD NW
Second Line	:	SUITE 620
City	:	ATLANTA
State	:	GA
Zip	:	30305-2153
Country	:	US
Telephone Number	:	404-219-1679
Fax Number	:	404-521-4709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/11/2010

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