Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1508442484 |
---|---|
Provider Name | Ivelisse M Ramos Vega |
First Address | Friendswood, TX 77546-2622 |
Second Address | Friendswood, TX 77546-2622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2021 |
Last Update Date | 22/03/2021 |