Provider Demographics
NPI:1255830659
Name:LINDGREN, MARISSA JOY (MS)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JOY
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:JOY
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1776 S JACKSON ST STE 503
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 503
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3851
Practice Address - Country:US
Practice Address - Phone:509-860-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.00001471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health