Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 071008714 | IL |
N | 103TC0700X | Clinical Psychologist | 071008714 | IL |
N | 103G00000X | Clinical Psychologist | 20042743A | IN |
N | 103TC0700X | Clinical Psychologist | 20042743A | IN |
Y | 103G00000X | Clinical Psychologist | 38042 | TX |
Y | 103TC0700X | Clinical Psychologist | 38042 | TX |
NPI | 1003231135 |
---|---|
Provider Name | Dr. Elizabeth Marnix |
First Address | Chicago, IL 60602-3830 |
Second Address | Austin, TX 78705-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2014 |
Last Update Date | 21/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | IN |