Provider Demographics
NPI:1114485976
Name:CHABAI, MARISSA E (LPC, RN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:E
Last Name:CHABAI
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:E
Other - Last Name:HEEBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 MAYNARD ST STE 402
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2282
Mailing Address - Country:US
Mailing Address - Phone:269-998-1005
Mailing Address - Fax:
Practice Address - Street 1:102 GERANIUM WAY
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:CO
Practice Address - Zip Code:80422-4315
Practice Address - Country:US
Practice Address - Phone:703-402-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1629875163W00000X
COLPC.0019399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse