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Individual
MARISSA BLANCO
Active
Individual
MARISSA BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, FNP
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10875
TX
363LF0000X
Family Nurse Practitioner
Primary
760444
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028736901
—
TX
Enumeration date
07/27/2005
Last updated
08/13/2024
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