Provider Demographics
NPI:1063633972
Name:SINES, MARYLYN CHRISTINE (PHD, PA)
Entity Type:Individual
Prefix:DR
First Name:MARYLYN
Middle Name:CHRISTINE
Last Name:SINES
Suffix:
Gender:F
Credentials:PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 KELLER PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3758
Mailing Address - Country:US
Mailing Address - Phone:972-916-0099
Mailing Address - Fax:817-431-5355
Practice Address - Street 1:1858 KELLER PKWY STE D
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3758
Practice Address - Country:US
Practice Address - Phone:972-916-0099
Practice Address - Fax:817-431-5355
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7357103T00000X
TX36102103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical