Provider Demographics
NPI:1578695508
Name:REIERSON, MARY GENEVIEVE (SUZY) (LPC LCDC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GENEVIEVE (SUZY)
Last Name:REIERSON
Suffix:
Gender:F
Credentials:LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4303
Mailing Address - Country:US
Mailing Address - Phone:713-447-2510
Mailing Address - Fax:713-226-3487
Practice Address - Street 1:818 HAROLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-4303
Practice Address - Country:US
Practice Address - Phone:713-447-2510
Practice Address - Fax:713-226-3487
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2781101YA0400X
TX13310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional