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General NPI Number Information
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NPI Number | 1083429534
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Entity Type | Individual
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Provider Name | MARISA ELAINE LANSLEY MA, APCC
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Gender | Female
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 140 E COMMONWEALTH AVE
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City | FULLERTON
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State | CA
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Zip | 92832-1905
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Country | US
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Telephone | 949-610-8966
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Fax |
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Provider Business Mailing Address
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Address Line | 2983 LONGSPUR DR
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City | FULLERTON
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State | CA
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Zip | 92835-2320
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Country | US
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Telephone | 714-488-6051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13102
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License Number State | CA
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