Provider Demographics
NPI:1639827512
Name:HABE, MARIELY JUDITH
Entity Type:Individual
Prefix:
First Name:MARIELY
Middle Name:JUDITH
Last Name:HABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 BLANCO RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4361
Mailing Address - Country:US
Mailing Address - Phone:714-579-9472
Mailing Address - Fax:
Practice Address - Street 1:7400 BLANCO RD STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4361
Practice Address - Country:US
Practice Address - Phone:714-579-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-206588106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician