Provider Demographics
NPI:1679649313
Name:EISNER, JOAN MARYLYN (LMSW ACP LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARYLYN
Last Name:EISNER
Suffix:
Gender:F
Credentials:LMSW ACP LMFT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARYLYN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW ACP LMFT
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586
Mailing Address - Country:US
Mailing Address - Phone:281-468-0997
Mailing Address - Fax:281-332-9930
Practice Address - Street 1:620 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-468-0997
Practice Address - Fax:281-332-9930
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153571041C0700X
TX003689016822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXW50002398OtherTRI CARE
TXW50002398Medicaid
O05236Medicare UPIN