Provider Demographics
NPI:1437591872
Name:BLOCK, MARILEE JANE (LPC, PLLC)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:JANE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LPC, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3046
Mailing Address - Country:US
Mailing Address - Phone:972-923-0730
Mailing Address - Fax:972-923-3886
Practice Address - Street 1:508 GRACE ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3046
Practice Address - Country:US
Practice Address - Phone:214-463-8587
Practice Address - Fax:972-923-3886
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional