Provider Demographics
NPI:1972580876
Name:ALVAREZ, MARY ALISON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALISON
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11412 BEE CAVES RD STE 217
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5575
Mailing Address - Country:US
Mailing Address - Phone:832-720-5020
Mailing Address - Fax:281-996-1355
Practice Address - Street 1:11412 BEE CAVES RD STE 217
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5575
Practice Address - Country:US
Practice Address - Phone:832-720-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0314734 -01Medicaid
TX0314734Medicaid
TX0094BTMedicare ID - Type UnspecifiedMEDICARE #