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General NPI Number Information
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NPI Number | 1376394460
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Entity Type | Individual
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Provider Name | MARISSA JEANNE LECOUNT
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2455 BENNETT VALLEY RD STE B209
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City | SANTA ROSA
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State | CA
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Zip | 95404-5669
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Country | US
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Telephone | 707-224-8266
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 351
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City | MONTE RIO
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State | CA
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Zip | 95462-0351
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Country | US
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Telephone | 650-208-4203
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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