Provider Demographics
NPI:1881279289
Name:KEES, MARISSA LEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:LEE
Last Name:KEES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:LEE
Other - Last Name:WHIDDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2117 BEAUREGARD PL
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4707
Mailing Address - Country:US
Mailing Address - Phone:318-230-2810
Mailing Address - Fax:
Practice Address - Street 1:185 BURT BLVD STE B
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-4904
Practice Address - Country:US
Practice Address - Phone:318-935-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional