Marissa Ealy

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

91376 Issued in TX

Practice address

303 S Highway 78 Ste 100
Wylie, TX 75098-3957

Phone

(469) 342-3468

NPI assigned

Apr 3, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CCNT Inc.

  • Clinical Social Worker
  • Wylie, TX
  • NPI 1912447681
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1629773262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 HACKBERRY CRK",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751811295",
            "telephone_number": "972-804-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S HIGHWAY 78 STE 100",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750983957",
            "telephone_number": "469-342-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EALY",
        "first_name": "MARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "91376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dysonfit LLC
• Eale Dental
• Rosemary Naomi Ebem, RN
• Hannah Eboagu, MCN, RD, LD
• Ubong Edohoukwa, PT, DPT
• Emily Eggart, DDS
• Charles Offiong Ekpe

• Professional Counselor in Wylie, TX
• Providers in Wylie, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.