Individual
MARISSA JADE BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1603 CAPITOL AVE STE 413C1005, CHEYENNE, WY 82001-4569
(307) 364-3181
(855) 915-1521
Mailing address
2390 WEDGEWOOD DR UNIT 6250, AKRON, OH 44312-2479
(888) 238-1818
(855) 915-1521
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-396396
WY
Other
Enumeration date
12/02/2024
Last updated
12/02/2024
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