Provider Demographics
NPI:1578014684
Name:SEBASTIAN, MARISSA JEREE (BS,BA,CC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JEREE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:BS,BA,CC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA,BS,CC
Mailing Address - Street 1:102 W CLIPPER ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1910
Mailing Address - Country:US
Mailing Address - Phone:573-559-6404
Mailing Address - Fax:
Practice Address - Street 1:102 W CLIPPER ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1910
Practice Address - Country:US
Practice Address - Phone:573-559-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician