Healthcare Provider Details

I. General information

NPI: 1114485976
Provider Name (Legal Business Name): MARISSA E CHABAI LPC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA E HEEBNER

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GERANIUM WAY
BLACK HAWK CO
80422-4315
US

IV. Provider business mailing address

333 MAYNARD ST STE 402
ANN ARBOR MI
48104-2282
US

V. Phone/Fax

Practice location:
  • Phone: 703-402-2556
  • Fax:
Mailing address:
  • Phone: 269-998-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1629875
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0019399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: