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NPI Code Detail

MEDICARE: MS. STASIA GORBACHEV MARZAN M.A., LPCC

MEDICARE: MS. STASIA GORBACHEV MARZAN M.A., LPCC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0089201NM

General Provider Information

NPI Number : 1972713238
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STASIA GORBACHEV MARZAN M.A., LPCC
Provider Business Mailing Address
First Line : 172 MONTANO RD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-5030
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 203 CALIFORNIA ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-1802
Country : US
Telephone Number : 505-308-8296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 05/25/2021

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