Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 38750 | TX |
Y | 103TC0700X | Clinical Psychologist | 38750 | TX |
NPI | 1003584665 |
---|---|
Provider Name | Marianne Carlson |
First Address | Houston, TX 77030-2717 |
Second Address | Houston, TX 77030-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 20/09/2021 |