Provider Demographics
NPI:1750314043
Name:FETZER, MARY B
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:FETZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:FETZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:909 FROSTWOOD DR STE 258
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2309
Mailing Address - Country:US
Mailing Address - Phone:713-465-7076
Mailing Address - Fax:281-591-7459
Practice Address - Street 1:909 FROSTWOOD DR STE 258
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2309
Practice Address - Country:US
Practice Address - Phone:713-465-7076
Practice Address - Fax:281-591-7459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23840103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling