Provider Demographics
NPI:1316073075
Name:MARISCAL, MARISOL (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:MARISCAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 LOCH LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3205
Mailing Address - Country:US
Mailing Address - Phone:805-264-7231
Mailing Address - Fax:
Practice Address - Street 1:354 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3876
Practice Address - Country:US
Practice Address - Phone:805-474-7471
Practice Address - Fax:805-473-7124
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000009153Medicare UPIN