Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 17843 | TX |
NPI | 1003001074 |
---|---|
Provider Name | Dr. Dalia Mattis |
First Address | Houston, TX 77092-2024 |
Second Address | Houston, TX 77092-2024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165725601 | (05) | TX |