Individual
MARION W MAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 461-4018
Mailing address
1518 S 3RD ST, IRONTON, OH 45638-2140
(740) 532-7855
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
111037
OH
101YM0800X
Mental Health Counselor
Primary
E0701119
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09425
—
OH
Enumeration date
03/10/2009
Last updated
04/01/2024
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