Liburd, Queen Marisha

Liburd, Queen Marisha is an individual health care provider with primary practice located at 6 Eagle Ctr Ste 1 , O Fallon IL 62269-1945. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Liburd, Queen Marisha can be contacted via phone (618) 206-8816.

Contact Information

Primary practice address
6 Eagle Ctr Ste 1 O Fallon IL 62269-1945
Phone: (618) 206-8816
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X

Profile Details

NPI number 1871100768
LBN Legal business name Liburd, Queen Marisha
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2020
Last updated Sep 25th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871100768 NPPES
Illinois MEDICAID 352581680

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