Provider Demographics
NPI:1275193831
Name:MUNDELL, MARISA (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MUNDELL
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 VIZCAYA DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-5903
Mailing Address - Country:US
Mailing Address - Phone:908-418-6766
Mailing Address - Fax:
Practice Address - Street 1:9013 UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9421
Practice Address - Country:US
Practice Address - Phone:850-478-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00589200101YM0800X
FLMH19560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health