Provider Demographics
NPI:1295322618
Name:FALICKI, MARISSA O (LPC)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:O
Last Name:FALICKI
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 1:150 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-9611
Mailing Address - Country:US
Mailing Address - Phone:951-751-3577
Mailing Address - Fax:
Practice Address - Street 1:1223 CAMELLIA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7220
Practice Address - Country:US
Practice Address - Phone:951-751-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty