Provider Demographics
NPI:1972713238
Name:MARZAN, STASIA GORBACHEV (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:STASIA
Middle Name:GORBACHEV
Last Name:MARZAN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MS
Other - First Name:STASIA
Other - Middle Name:
Other - Last Name:HEALINGBEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:172 MONTANO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 CALIFORNIA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1802
Practice Address - Country:US
Practice Address - Phone:505-308-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0089201101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional