Provider Demographics
NPI:1770280273
Name:NELSON, MARISSA E (LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:E
Last Name:NELSON
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 1:13801 NAPOLI DR. #9203
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:713-309-0053
Mailing Address - Fax:
Practice Address - Street 1:12340 JONES ROAD, STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2892
Practice Address - Country:US
Practice Address - Phone:832-756-2749
Practice Address - Fax:832-201-1151
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770280273Medicaid