Provider Demographics
NPI:1609237866
Name:WEBB, MARISSA (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-0613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19102 S BLACKHAWK PKWY
Practice Address - Street 2:SUITE 25E
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8985
Practice Address - Country:US
Practice Address - Phone:708-473-2445
Practice Address - Fax:815-521-1889
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional