Provider Demographics
NPI:1194526871
Name:MARLIS, KONSTANTINA NICOLE
Entity type:Individual
Prefix:
First Name:KONSTANTINA
Middle Name:NICOLE
Last Name:MARLIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N81W32011 SHENANDOAH CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9741
Mailing Address - Country:US
Mailing Address - Phone:262-313-7090
Mailing Address - Fax:
Practice Address - Street 1:N81W32011 SHENANDOAH CT
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9741
Practice Address - Country:US
Practice Address - Phone:262-313-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health