Provider Demographics
NPI:1689816837
Name:RATTANAPOTE, MARLAYNA ELIZABETH (LPCC)
Entity Type:Individual
Prefix:
First Name:MARLAYNA
Middle Name:ELIZABETH
Last Name:RATTANAPOTE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 BALBOA AVE # 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:858-414-3651
Mailing Address - Fax:
Practice Address - Street 1:4940 CORRALES RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8673
Practice Address - Country:US
Practice Address - Phone:858-414-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT - 0121911101YM0800X
CA10634101YP2500X
NMT-0142131101YP2500X
NM0147991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36384267Medicaid