Provider Demographics
NPI:1730199753
Name:MARSHALL, LONNIE R (LMFT)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 COUNCIL ST NE
Mailing Address - Street 2:120
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5878
Mailing Address - Country:US
Mailing Address - Phone:319-393-6796
Mailing Address - Fax:319-378-8621
Practice Address - Street 1:5925 COUNCIL ST NE
Practice Address - Street 2:120
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5878
Practice Address - Country:US
Practice Address - Phone:319-393-6796
Practice Address - Fax:319-378-8621
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist