Provider Demographics
NPI:1699883090
Name:MARKER, JACK CODELL (LPC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CODELL
Last Name:MARKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 STOYSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-6945
Mailing Address - Country:US
Mailing Address - Phone:814-445-6915
Mailing Address - Fax:814-443-6019
Practice Address - Street 1:409 STOYSTOWN RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-6945
Practice Address - Country:US
Practice Address - Phone:814-445-6915
Practice Address - Fax:814-443-6019
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional