Provider Demographics
NPI:1457869034
Name:MARQUEZ AYALA, ADRIAN M (LMHC)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:M
Last Name:MARQUEZ AYALA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 58TH AVE # 318
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-4647
Mailing Address - Country:US
Mailing Address - Phone:772-307-9840
Mailing Address - Fax:
Practice Address - Street 1:6200 20TH ST STE 378
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1014
Practice Address - Country:US
Practice Address - Phone:321-345-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17648101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health