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General NPI Number Information
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NPI Number | 1952857435
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Entity Type | Individual
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Provider Name | MARISSA B SHENNAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 2142 N BLYTHE AVE
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City | FRESNO
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State | CA
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Zip | 93722-5402
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Country | US
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Telephone | 559-276-7680
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Fax |
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Provider Business Mailing Address
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Address Line | 13867 W HWY 53 #605
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City | RATHDRUM
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State | ID
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Zip | 83858-0236
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Country | US
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Telephone | 559-997-6270
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T2530
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-8351
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 94199
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License Number State | CA
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