Provider Demographics
NPI:1629735717
Name:MARBEN, LISA (LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARBEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463142 STATE ROAD 200
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5554
Mailing Address - Country:US
Mailing Address - Phone:904-225-8280
Mailing Address - Fax:
Practice Address - Street 1:463142 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5554
Practice Address - Country:US
Practice Address - Phone:904-225-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health