Provider Demographics
NPI:1659613594
Name:REPP, MARCUS RAY
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:RAY
Last Name:REPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5844
Mailing Address - Country:US
Mailing Address - Phone:832-465-1902
Mailing Address - Fax:
Practice Address - Street 1:1610 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5844
Practice Address - Country:US
Practice Address - Phone:832-465-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)