Provider Demographics
NPI:1790890366
Name:FARISS, CATHY TINA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:TINA
Last Name:FARISS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:CATHY
Other - Middle Name:TINA
Other - Last Name:MARCHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3530 BEE CAVE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5391
Mailing Address - Country:US
Mailing Address - Phone:512-577-9932
Mailing Address - Fax:
Practice Address - Street 1:3530 BEE CAVE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5391
Practice Address - Country:US
Practice Address - Phone:512-577-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6227LCOtherBCBS PROVIDER NUMBER