Provider Demographics
NPI:1639277809
Name:FERRIS, DANA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:FERRIS
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:PO BOX 93042
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-3042
Mailing Address - Country:US
Mailing Address - Phone:512-462-0056
Mailing Address - Fax:
Practice Address - Street 1:4701 WEST GATE BLVD
Practice Address - Street 2:BUILDING D #403
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-462-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058CMOtherBCBS
TX00127EMedicare PIN