Provider Demographics
NPI:1518519370
Name:MARSH, LYRICE A (MDIV)
Entity Type:Individual
Prefix:
First Name:LYRICE
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 S MAIN ST # 165
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4690
Mailing Address - Country:US
Mailing Address - Phone:310-402-9079
Mailing Address - Fax:
Practice Address - Street 1:25421 MAXIMUS ST
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4647
Practice Address - Country:US
Practice Address - Phone:310-402-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral