Provider Demographics
NPI:1144430745
Name:MAYBERRY, MARINA MARIAN (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:MARIAN
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 PROFESSIONAL PL STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8106
Mailing Address - Country:US
Mailing Address - Phone:719-330-5554
Mailing Address - Fax:719-325-8943
Practice Address - Street 1:2950 PROFESSIONAL PL STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8106
Practice Address - Country:US
Practice Address - Phone:719-330-5554
Practice Address - Fax:719-325-8943
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist