Provider Demographics
NPI:1841323599
Name:GARCIA, MARISSA GONZALEZ (MS, MFTI)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:GONZALEZ
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 SAN DIMAS
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91733
Mailing Address - Country:US
Mailing Address - Phone:909-480-8900
Mailing Address - Fax:909-599-1329
Practice Address - Street 1:1264 SAN DIMAS
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91733
Practice Address - Country:US
Practice Address - Phone:909-480-8900
Practice Address - Fax:909-599-1329
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner