Provider Demographics
NPI:1104456482
Name:BEAN MORELAND, MARION CAROL
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:CAROL
Last Name:BEAN MORELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MIDDLETOWN CMNS STE 130
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-0168
Mailing Address - Country:US
Mailing Address - Phone:303-588-8296
Mailing Address - Fax:
Practice Address - Street 1:2600 MIDDLETOWN CMNS STE 130
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-0168
Practice Address - Country:US
Practice Address - Phone:303-588-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV549101YM0800X
WV2585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health