Provider Demographics
NPI:1346486750
Name:REYNOLDS, MARISA LYNN
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARISA
Other - Middle Name:LYNN
Other - Last Name:PISANESCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5071
Practice Address - Street 1:7862 W MANSFIELD PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-1934
Practice Address - Country:US
Practice Address - Phone:303-987-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health