Provider Demographics
NPI:1649896762
Name:AYALA, MARISA ARIEL (LPC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ARIEL
Last Name:AYALA
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 1:1999 E WILSON LN APT C
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2378
Mailing Address - Country:US
Mailing Address - Phone:443-538-2426
Mailing Address - Fax:
Practice Address - Street 1:123 N YALE ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-2340
Practice Address - Country:US
Practice Address - Phone:208-585-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6966101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty