Individual provider · Type 1 NPI

Marissa Lee Lodge

Counselor · Rockford, IL

NPI number 1467986331 Active

Practice location

8616 Northern Ave
Rockford, IL 61107-5309

Call (815) 332-8003 Map

Mailing address

1021 N Mulford Rd
Rockford, IL 61107-3877

Specialties and licenses

TaxonomyCodeLicense
Behavior Technician 106S00000XNone listed
Counselor Primary 101Y00000XNone listed

Counselor: A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

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About NPI 1467986331

Marissa Lee Lodge's National Provider Identifier is 1467986331, issued on Apr 17, 2017. The primary taxonomy on file is Counselor (101Y00000X), and the practice location is in Rockford, IL. The record was last updated on Aug 3, 2018.