Provider Demographics
NPI:1114526795
Name:POLLARD, MARISSA (MA, LMFT, RPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:MA, LMFT, RPT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5233 S 50 E
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-8011
Mailing Address - Country:US
Mailing Address - Phone:260-563-1158
Mailing Address - Fax:
Practice Address - Street 1:5233 S 50 E
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-8011
Practice Address - Country:US
Practice Address - Phone:260-563-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002115A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health