Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 68232 | TX |
NPI | 1003157165 |
---|---|
Provider Name | Sherry Marasse |
First Address | Arp, TX 75750-4502 |
Second Address | Tyler, TX 75702-7337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2013 |
Last Update Date | 13/03/2013 |