Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist |
NPI | 1447903521 |
---|---|
Provider Name | Clarissa Reid |
First Address | Houston, TX 77084-1638 |
Second Address | Houston, TX 77084-1638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2022 |
Last Update Date | 30/01/2022 |