Provider Demographics
NPI:1356364814
Name:DENNIS, MARIBETH (PHD)
Entity type:Individual
Prefix:MS
First Name:MARIBETH
Middle Name:
Last Name:DENNIS
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 1:2421 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79411-1301
Mailing Address - Country:US
Mailing Address - Phone:806-792-8039
Mailing Address - Fax:806-792-8039
Practice Address - Street 1:2421 27TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79411-1301
Practice Address - Country:US
Practice Address - Phone:806-792-8039
Practice Address - Fax:806-792-8039
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14621101YP2500X
TX2095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist