Provider Demographics
NPI:1356744072
Name:LONNGI, MARISSA (LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LONNGI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-0115
Mailing Address - Country:US
Mailing Address - Phone:832-857-9382
Mailing Address - Fax:
Practice Address - Street 1:771 E SOUTHLAKE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6576
Practice Address - Country:US
Practice Address - Phone:832-954-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67443101YP2500X
TX67743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty