Provider Demographics
NPI:1497288617
Name:DAVALA, MARISSA (PHD, LIMHP, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:DAVALA
Suffix:
Gender:F
Credentials:PHD, LIMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 CENTRAL AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8126
Mailing Address - Country:US
Mailing Address - Phone:402-418-1061
Mailing Address - Fax:
Practice Address - Street 1:3710 CENTRAL AVE STE 4
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8126
Practice Address - Country:US
Practice Address - Phone:402-418-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health