Provider Demographics
NPI:1801042429
Name:ANIGBO, TRESSIE K (MASP)
Entity Type:Individual
Prefix:
First Name:TRESSIE
Middle Name:K
Last Name:ANIGBO
Suffix:
Gender:F
Credentials:MASP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E
Mailing Address - Street 2:BLDG 4; SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7727
Mailing Address - Country:US
Mailing Address - Phone:903-269-3969
Mailing Address - Fax:903-269-3523
Practice Address - Street 1:3900 JOE RAMSEY BLVD E
Practice Address - Street 2:BLDG 4; SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7727
Practice Address - Country:US
Practice Address - Phone:903-269-3969
Practice Address - Fax:903-269-3523
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31459103T00000X, 103TB0200X, 103TC1900X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool