Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 34011 | TX |
Y | 103TC0700X | Clinical Psychologist | 34011 | TX |
N | 103G00000X | Clinical Psychologist | 34011 | TX |
N | 103TC0700X | Clinical Psychologist | 34011 | TX |
N | 103TC1900X | Counseling Psychologist | 34011 | TX |
N | 103TE1100X | Exercise & Sports Psychologist | 34011 | TX |
N | 103TH0004X | Health Psychologist | 34011 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 34011 | TX |
NPI | 1417960840 |
---|---|
Provider Name | Mark T Barisa |
First Address | Frisco, TX 75035-0225 |
Second Address | Frisco, TX 75033-1609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 29/12/2021 |