Provider Demographics
NPI:1306694534
Name:BEMIS, MARILYN DWYER
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:DWYER
Last Name:BEMIS
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 1:6235 TWIN OAKS DR APT 2316
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8318
Mailing Address - Country:US
Mailing Address - Phone:850-339-3414
Mailing Address - Fax:
Practice Address - Street 1:509 SCOTT AVE STE 100
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-1293
Practice Address - Country:US
Practice Address - Phone:719-286-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020015101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor