Provider Demographics
NPI:1689546889
Name:SKEELS, MARISA MARIE
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:MARIE
Last Name:SKEELS
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 1:600 N HUMBOLDT AVE APT 283
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-3536
Mailing Address - Country:US
Mailing Address - Phone:209-926-6786
Mailing Address - Fax:
Practice Address - Street 1:600 N HUMBOLDT AVE
Practice Address - Street 2:APT 283
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-3536
Practice Address - Country:US
Practice Address - Phone:209-926-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty