Provider Demographics
NPI:1760371934
Name:WONG, MARISSA COLLINS
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:COLLINS
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-4121
Mailing Address - Country:US
Mailing Address - Phone:915-383-5862
Mailing Address - Fax:
Practice Address - Street 1:2905 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-4121
Practice Address - Country:US
Practice Address - Phone:915-383-5862
Practice Address - Fax:915-383-5862
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional