Healthcare Provider Details

I. General information

NPI: 1689546889
Provider Name (Legal Business Name): MARISA MARIE SKEELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HUMBOLDT AVE APT 283
WILLOWS CA
95988-3536
US

IV. Provider business mailing address

600 N HUMBOLDT AVE APT 283
WILLOWS CA
95988-3536
US

V. Phone/Fax

Practice location:
  • Phone: 209-926-6786
  • Fax:
Mailing address:
  • Phone: 209-926-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: