Provider Demographics
NPI:1467159616
Name:MARQUEZ, ADDIE LYNN (LPA-INDEPENDENT)
Entity Type:Individual
Prefix:MRS
First Name:ADDIE
Middle Name:LYNN
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LPA-INDEPENDENT
Other - Prefix:
Other - First Name:ADDIE
Other - Middle Name:LYNN
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GOT MARRIED RECENTLY
Mailing Address - Street 1:1207 S BRYANT BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-7223
Mailing Address - Country:US
Mailing Address - Phone:325-718-4590
Mailing Address - Fax:
Practice Address - Street 1:1207 S BRYANT BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-7223
Practice Address - Country:US
Practice Address - Phone:325-718-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist