Provider Demographics
NPI:1225125099
Name:MARZEC, MITCHELL (LPCC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MARZEC
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 LAFAYETTE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1160
Mailing Address - Country:US
Mailing Address - Phone:505-265-1016
Mailing Address - Fax:
Practice Address - Street 1:1601 LAFAYETTE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1160
Practice Address - Country:US
Practice Address - Phone:505-265-1016
Practice Address - Fax:505-265-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0094541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45385Medicaid