Provider Demographics
NPI:1821286071
Name:BERRY, FERNALD Z
Entity Type:Individual
Prefix:
First Name:FERNALD
Middle Name:Z
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 MOSSY PATH LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4961
Mailing Address - Country:US
Mailing Address - Phone:714-588-5324
Mailing Address - Fax:
Practice Address - Street 1:12340 JONES ROAD, STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2892
Practice Address - Country:US
Practice Address - Phone:832-756-2749
Practice Address - Fax:859-201-1151
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT81719106H00000X
TX204225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist