Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MARISSA ANN WIDENER LPC
NPI 1104525880
Counselor - Professional in Phoenix, AZ

Q: What is Marissa Widener's NPI number?

The NPI number for Marissa Widener is 1104525880. It was assigned to this individual provider in the NPPES registry on March 1, 2023.

Q: What is Marissa Widener's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Marissa Widener was last updated on June 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 59 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 01, 2023PECOS Enrolled

3033 N CENTRAL AVE STE 700, PHOENIX, AZ 85012(602) 230-7373(602) 682-7455 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 30, 2026, Mar 1, 2023 (2 updates tracked since 2023).

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About Marissa Ann Widener Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARISSA ANN WIDENER LPC (NPI 1104525880) is an individual professional provider in Phoenix, Arizona, licensed in Arizona (LPC-24585) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and maintains a secondary practice location in Phoenix.

NPPES Registry Identity

NPI1104525880

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameMARISSA ANN WIDENERCredential: LPC

Location Address3033 N CENTRAL AVE STE 700Phoenix, AZ 85012-2806

Mailing Address3101 N Central Ave Ste 550Phoenix, AZ 85012-2635 · (602) 230-7373 · Fax (602) 682-7455

Phone(602) 230-7373

Fax(602) 682-7455

Sole ProprietorNo

Enumeration DateMarch 1, 2023

Last NPPES UpdateJune 10, 20262 updates tracked since enumeration

NPPES CertifiedJune 10, 2026

✔ NPI 1104525880 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in AZ · LPC-24585

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License LPC-24585 (AZ)

3033 N CENTRAL AVE STE 700, Phoenix, AZ 85012

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Secondary Practice Location 1

Location 12211 E Highland Ave Ste 205Phoenix, AZ 85016-4834 · Phone (888) 661-2742 · Fax (312) 275-7663

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Marissa Ann Widener Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FERNANDA BARRAGAN GARCIA LMSW

Social Worker (Clinical)