MEDICARE: MARISSA GENE STITT MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	01619	MN

General Provider Information

NPI Number	:	1982002721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA GENE STITT MS, LPC

Provider Business Mailing Address
First Line	:	PO BOX 1188
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-1188
Country	:	US
Telephone Number	:	218-749-2881
Fax Number	:	218-749-3806

Provider Business Practice Location Address
First Line	:	214 CHANDLER AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1675
Country	:	US
Telephone Number	:	218-471-4327
Fax Number	:	218-744-9632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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