Provider Demographics
NPI:1205829587
Name:REILLY, MARA A (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:A
Last Name:REILLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WHITE DOVE PASS
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2947
Mailing Address - Country:US
Mailing Address - Phone:512-514-0474
Mailing Address - Fax:830-598-1614
Practice Address - Street 1:2300 WHITE DOVE PASS
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-2947
Practice Address - Country:US
Practice Address - Phone:512-514-0474
Practice Address - Fax:830-598-1614
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist