Provider Demographics
NPI:1679965370
Name:EGGLESTON, MARNE PRETTYMAN (LPC-S, NCC, MAC)
Entity type:Individual
Prefix:MS
First Name:MARNE
Middle Name:PRETTYMAN
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:LPC-S, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 E TUDOR RD # 995
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1185
Mailing Address - Country:US
Mailing Address - Phone:907-444-4526
Mailing Address - Fax:844-927-4589
Practice Address - Street 1:2440 E TUDOR RD # 995
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1185
Practice Address - Country:US
Practice Address - Phone:907-444-4526
Practice Address - Fax:844-927-4589
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1502031101YM0800X
HIMHC-610101YM0800X
UT11952273-6004101YM0800X
NVCP5097-R101YP2500X
AK123531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health