Provider Demographics
NPI:1164105441
Name:ARREOLA, MARISSA MARIE
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARIE
Last Name:ARREOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:MARIE
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1039 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4581
Mailing Address - Country:US
Mailing Address - Phone:831-524-9208
Mailing Address - Fax:
Practice Address - Street 1:1039 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-4581
Practice Address - Country:US
Practice Address - Phone:831-524-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY6396763106S00000X
CAY6393763106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician