Provider Demographics
NPI:1134287790
Name:PASK, ANNALISA MARTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNALISA
Middle Name:MARTIN
Last Name:PASK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNALISA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8140 WALNUT HILL LANE
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-553-0180
Mailing Address - Fax:214-221-7188
Practice Address - Street 1:8140 WALNUT HILL LANE
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-553-0180
Practice Address - Fax:214-221-7188
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A50LOtherBCBS