Provider Demographics
NPI:1073593075
Name:DU BUISSON, MARIE-ELISE (PHD)
Entity Type:Individual
Prefix:
First Name:MARIE-ELISE
Middle Name:
Last Name:DU BUISSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 MCPHERSON AVE
Mailing Address - Street 2:#252
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6834
Mailing Address - Country:US
Mailing Address - Phone:956-795-1343
Mailing Address - Fax:956-795-1363
Practice Address - Street 1:8610 MCPHERSON RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6305
Practice Address - Country:US
Practice Address - Phone:956-795-8325
Practice Address - Fax:956-795-8335
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86728AOtherBLUE CROSS BLUE SHIELD
TX86728AOtherBLUE CROSS BLUE SHIELD
TXS39730Medicare UPIN