Marissa Rae Abbott, LPC
Individual provider Active NPI Professional Counselor · Jefferson City, MO
NPI 1780163436 · NPPES record last updated Jun 11, 2020
Key facts
- NPI
- 1780163436
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2013026604 (MO)
- Practice address
- 1905 Stadium Blvd
Jefferson City, MO 65109-1961 - Phone
- (888) 403-1071
- NPI assigned
- Aug 13, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241021002204 | ID | Practitioner - Mental Health Counselor | 5890993745 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013026604 | MO | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2013026604 | MO | Yes |
Addresses
Primary practice location
1905 Stadium Blvd
Jefferson City, MO 65109-1961
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other names
- Marissa Rae Bond
Other providers in Jefferson City, MO
- 360 Wellness LLC
- Makenzie Lynn Abbott
- William K Abbott
- Amber Lynn Abeln
- Kathy Abeln
- Access for Interpretations &Translations of Hispanic Service
- Osvaldo Acosta-Rodriguez
All providers in Jefferson City, MO · Professional Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.