Provider Demographics
NPI:1831086768
Name:MARSHALL, PHOENIX GRACE
Entity type:Individual
Prefix:
First Name:PHOENIX
Middle Name:GRACE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4349
Mailing Address - Country:US
Mailing Address - Phone:318-751-3097
Mailing Address - Fax:
Practice Address - Street 1:4202 N INTERSTATE 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METARIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:318-751-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician