Provider Demographics
NPI:1407622558
Name:DAYLEY, MARISSA LYNN HALL
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN HALL
Last Name:DAYLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LYNN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:694 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7604
Mailing Address - Country:US
Mailing Address - Phone:360-521-0632
Mailing Address - Fax:
Practice Address - Street 1:2440 WILLAMETTE ST STE 201
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3170
Practice Address - Country:US
Practice Address - Phone:541-321-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health