Provider Demographics
NPI:1700255064
Name:BIGNESS, MARINA E
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:E
Last Name:BIGNESS
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 1:12105 OAKALLA RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-2568
Mailing Address - Country:US
Mailing Address - Phone:254-258-8043
Mailing Address - Fax:
Practice Address - Street 1:12105 OAKALLA RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-2568
Practice Address - Country:US
Practice Address - Phone:254-258-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical