Provider Demographics
NPI:1417963216
Name:PHARIS, MARY EVANS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:EVANS
Last Name:PHARIS
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 1:5400-B RIDGE OAK DR.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4816
Mailing Address - Country:US
Mailing Address - Phone:512-453-2155
Mailing Address - Fax:512-458-8574
Practice Address - Street 1:5400-B RIDGE OAK DR.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4816
Practice Address - Country:US
Practice Address - Phone:512-453-2155
Practice Address - Fax:512-458-8574
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F30COtherMY BCBS-TX PROVIDER NUMBE