Provider Demographics
NPI:1093170219
Name:MARISSA R ABBOTT
Entity Type:Organization
Organization Name:MARISSA R ABBOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-286-5023
Mailing Address - Street 1:722 HOBBS RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6819
Mailing Address - Country:US
Mailing Address - Phone:573-286-5023
Mailing Address - Fax:
Practice Address - Street 1:919 WILDWOOD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5798
Practice Address - Country:US
Practice Address - Phone:573-635-9654
Practice Address - Fax:573-635-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty