Provider Demographics
NPI:1295399707
Name:REISSINGER, MARY CASSONDRA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CASSONDRA
Last Name:REISSINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 RADCLIFFE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1106
Mailing Address - Country:US
Mailing Address - Phone:847-912-0653
Mailing Address - Fax:
Practice Address - Street 1:1502 TAUB LOOP STE 4.229
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-4909
Practice Address - Fax:713-873-4944
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical