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General NPI Number Information
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NPI Number | 1669348652
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Entity Type | Organization
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Legal Business Name | MARISSA CORNELIUS, LLC
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 312 N ELM ST STE 112
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City | GRAND ISLAND
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State | NE
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Zip | 68801-4509
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Country | US
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Telephone | 308-672-3174
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Fax |
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Provider Business Mailing Address
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Address Line | 1739 INGALLS ST
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City | GRAND ISLAND
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State | NE
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Zip | 68803-6138
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Country | US
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Telephone | 308-672-3174
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Fax |
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Authorized Official
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Title or Position | COUNSELING
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Name | MARISSA B CORNELIUS
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Credential | PLMHP, PMSW
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Telephone | 308-672-3174
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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 |
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License Number State |
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