Provider Demographics
NPI:1023820651
Name:LIZARDO, MARLENNE (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MARLENNE
Middle Name:
Last Name:LIZARDO
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 MONTWOOD DR STE N179
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-2701
Mailing Address - Country:US
Mailing Address - Phone:915-209-1030
Mailing Address - Fax:
Practice Address - Street 1:9104 SWEET ACACIA LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-2079
Practice Address - Country:US
Practice Address - Phone:915-209-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94678101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor