MEDICARE: MARISSA JEANNE LECOUNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	373H00000X	Day Training/Habilitation Specialist
3	172V00000X	Community Health Worker
4	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1376394460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA JEANNE LECOUNT

Provider Business Mailing Address
First Line	:	PO BOX 351
Second Line	:
City	:	MONTE RIO
State	:	CA
Zip	:	95462-0351
Country	:	US
Telephone Number	:	650-208-4203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 BENNETT VALLEY RD STE B209
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-5669
Country	:	US
Telephone Number	:	707-224-8266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	12/10/2025

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