Provider Demographics
NPI:1295527075
Name:SLABOSZ, MARISSA M (TLLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:SLABOSZ
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 S EAST TORCH LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49615-9350
Mailing Address - Country:US
Mailing Address - Phone:231-676-4205
Mailing Address - Fax:
Practice Address - Street 1:5034 S EAST TORCH LAKE DR
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9350
Practice Address - Country:US
Practice Address - Phone:231-676-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010150103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist