IndividualActive
Marissa Widener, MC, LAC
NPI 1104525880 · Mental Health Counselor · Phoenix, AZ
Provider details
- NPI number
- 1104525880
- Entity type
- Individual
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Credential
- MC, LAC
- Sex
- Female
- Sole proprietor
- No
- License
- LPC-24585 (AZ)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2211 E Highland Ave Ste 205
Phoenix, AZ 85016-4834
Phone: (888) 661-2742
Fax: (312) 275-7663
Street-level locationGet directions
Mailing address
1 N La Salle St Ste 1450
Chicago, IL 60602-4351
Registry dates
- Enumerated
- 2023-03-01
- Last updated
- 2026-01-30
- Certified
- 2026-01-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.