Provider Demographics
NPI:1437526985
Name:MARQUEZ TOBIN, TELISA SUE (MA)
Entity Type:Individual
Prefix:
First Name:TELISA
Middle Name:SUE
Last Name:MARQUEZ TOBIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TELISA
Other - Middle Name:SUE
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:550 W PLUMB LN STE B118
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3468
Mailing Address - Country:US
Mailing Address - Phone:775-338-8330
Mailing Address - Fax:
Practice Address - Street 1:10 SHERIDAN WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2419
Practice Address - Country:US
Practice Address - Phone:775-338-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5167101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor