Provider Demographics
NPI:1366242596
Name:MARKS, MONICA MARIE (MS, EDS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:MARKS
Suffix:
Gender:
Credentials:MS, EDS
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:MARIE
Other - Last Name:WYHOWANEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, EDS
Mailing Address - Street 1:2906 CARAVELLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-6146
Mailing Address - Country:US
Mailing Address - Phone:928-230-8058
Mailing Address - Fax:
Practice Address - Street 1:2906 CARAVELLE DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-6146
Practice Address - Country:US
Practice Address - Phone:928-230-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5549656103TS0200X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities