Provider Demographics
NPI:1265090096
Name:DSOUZA, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DSOUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LAKE VILLA DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4305
Mailing Address - Country:US
Mailing Address - Phone:832-452-7278
Mailing Address - Fax:
Practice Address - Street 1:5959 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2421
Practice Address - Country:US
Practice Address - Phone:832-831-3978
Practice Address - Fax:832-831-3978
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health