Provider Demographics
NPI:1083869838
Name:LEUALLEN, MARISSA JADE
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:JADE
Last Name:LEUALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARISSA
Other - Middle Name:JADE
Other - Last Name:ROBELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 SUNVIEW ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2229
Mailing Address - Country:US
Mailing Address - Phone:541-513-8514
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3758
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health