Provider Demographics
NPI:1497213680
Name:FRICKENSCHMIDT, MARISSA LEANNA (LIMHP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LEANNA
Last Name:FRICKENSCHMIDT
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11837 MIRACLE HILLS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4418
Mailing Address - Country:US
Mailing Address - Phone:402-277-9499
Mailing Address - Fax:
Practice Address - Street 1:11837 MIRACLE HILLS DR STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4418
Practice Address - Country:US
Practice Address - Phone:402-277-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health