Provider Demographics
NPI:1073038071
Name:MARCHANT, AIKA MARY
Entity Type:Individual
Prefix:
First Name:AIKA
Middle Name:MARY
Last Name:MARCHANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 BRODIE LANE
Mailing Address - Street 2:STE 160 PO BOX 1064
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:310-465-7314
Mailing Address - Fax:
Practice Address - Street 1:12 SOLDIERS FIELD PARK APT 12E
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02163-1736
Practice Address - Country:US
Practice Address - Phone:310-465-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX203360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program