Provider Demographics
NPI:1346064805
Name:LEMUS, MARISSA F (MS)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:F
Last Name:LEMUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 BURBANK BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2313
Mailing Address - Country:US
Mailing Address - Phone:818-294-8333
Mailing Address - Fax:
Practice Address - Street 1:3316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-4126
Practice Address - Country:US
Practice Address - Phone:213-856-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health