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General NPI Number Information
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NPI Number | 1497288617
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Entity Type | Individual
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Provider Name | MARISSA DAVALA PH.D., LIMHP, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 3710 CENTRAL AVE STE 4
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City | KEARNEY
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State | NE
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Zip | 68847-8126
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Country | US
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Telephone | 402-418-1061
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 CENTRAL AVE STE 4
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City | KEARNEY
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State | NE
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Zip | 68847-8126
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Country | US
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Telephone | 402-418-1061
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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 | 2551
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License Number State |
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