Provider Demographics
NPI:1033984414
Name:STICKLEY, MARIAH MONTGOMERY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:MONTGOMERY
Last Name:STICKLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:LEIGH
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9224 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-9329
Mailing Address - Country:US
Mailing Address - Phone:713-819-5273
Mailing Address - Fax:
Practice Address - Street 1:2900 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2622
Practice Address - Country:US
Practice Address - Phone:797-436-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39922103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist