Provider Demographics
NPI:1518551068
Name:AGUERO, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:AGUERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S HIGHWAY 78 STE 100-103
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3944
Mailing Address - Country:US
Mailing Address - Phone:469-342-3468
Mailing Address - Fax:469-342-3466
Practice Address - Street 1:303 S HIGHWAY 78 STE 100-103
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3944
Practice Address - Country:US
Practice Address - Phone:469-342-3468
Practice Address - Fax:469-342-3466
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional