Provider Demographics
NPI:1245418037
Name:KISSINGER, MARILYN (PHD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:KISSINGER
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 1:6370 LBJ FWY
Mailing Address - Street 2:SUITE 276
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6459
Mailing Address - Country:US
Mailing Address - Phone:972-788-9201
Mailing Address - Fax:972-788-0061
Practice Address - Street 1:6370 LBJ FWY
Practice Address - Street 2:SUITE 276
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6459
Practice Address - Country:US
Practice Address - Phone:972-788-9201
Practice Address - Fax:972-788-0061
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32601103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling