Basic Information
Provider Information
NPI: 1932706785
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRIS
FirstName: MARIANNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 E STASSNEY LN APT 1024
Address2:  
City: AUSTIN
State: TX
PostalCode: 787453398
CountryCode: US
TelephoneNumber: 7872250066
FaxNumber:  
Practice Location
Address1: 2410 E RIVERSIDE DR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787413083
CountryCode: US
TelephoneNumber: 5124724357
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/05/2020
LastUpdateDate: 10/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X80975TXN Behavioral Health & Social Service ProvidersCounselor 
101YP2500X80975TXY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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