Individual
MARISSA ANN WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MC, LAC
Contact information
Practice address
2211 E HIGHLAND AVE STE 205, PHOENIX, AZ 85016-4834
(888) 661-2742
(312) 275-7663
Mailing address
1 N LA SALLE ST STE 1450, CHICAGO, IL 60602-4351
(312) 578-9990
(312) 275-7663
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-21828
AZ
101YM0800X
Mental Health Counselor
Primary
LPC-24585
AZ
Other
Enumeration date
03/01/2023
Last updated
01/30/2026
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