Provider Demographics
NPI:1760508337
Name:EARNEST, MARY JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:EARNEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 N CAPITAL OF TEXAS HWY STE 304 BLDG 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6374
Mailing Address - Country:US
Mailing Address - Phone:512-346-8335
Mailing Address - Fax:512-346-1863
Practice Address - Street 1:9501 N CAPITAL OF TEXAS HWY STE 304 BLDG 3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6374
Practice Address - Country:US
Practice Address - Phone:512-346-8335
Practice Address - Fax:512-346-1863
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05301104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist