Provider Demographics
NPI:1225113772
Name:RISER, EARLENE ANN (PHD)
Entity Type:Individual
Prefix:
First Name:EARLENE
Middle Name:ANN
Last Name:RISER
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 1:5110 ARROWHEAD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-424-4846
Mailing Address - Fax:
Practice Address - Street 1:1600 JAMES BOWIE DRIVE
Practice Address - Street 2:SUITE C-106
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-427-0222
Practice Address - Fax:281-422-0702
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2259OtherLIC MARRIAGE FAMILY THERA
TX9182OtherLIC PROFESSIONAL COUNSELO