Provider Demographics
NPI:1144657610
Name:MARSH, MICHAEL JASON (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JASON
Last Name:MARSH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:KS
Mailing Address - Zip Code:66535-9621
Mailing Address - Country:US
Mailing Address - Phone:785-410-0469
Mailing Address - Fax:
Practice Address - Street 1:111 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:KS
Practice Address - Zip Code:66535-9621
Practice Address - Country:US
Practice Address - Phone:785-410-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional