Provider Demographics
NPI:1023982782
Name:MARISSA PHEGLEY LPC LLC
Entity type:Organization
Organization Name:MARISSA PHEGLEY LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHEGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-631-1142
Mailing Address - Street 1:202 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1705
Mailing Address - Country:US
Mailing Address - Phone:573-631-1142
Mailing Address - Fax:
Practice Address - Street 1:202 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1705
Practice Address - Country:US
Practice Address - Phone:573-631-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty