Provider Demographics
NPI:1942948989
Name:HODGES, MARISSA M (LPC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:HODGES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11837 LOWER 31ST ST N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-4472
Mailing Address - Country:US
Mailing Address - Phone:507-304-2370
Mailing Address - Fax:
Practice Address - Street 1:1155 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1288
Practice Address - Country:US
Practice Address - Phone:612-223-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health