Provider Demographics
NPI:1750757225
Name:MARILEE J. BLOCK, MA, LPC, PLLC
Entity type:Organization
Organization Name:MARILEE J. BLOCK, MA, LPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR : MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILEE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, PLLC
Authorized Official - Phone:214-301-2974
Mailing Address - Street 1:4836 FM 813
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-8910
Mailing Address - Country:US
Mailing Address - Phone:214-301-2974
Mailing Address - Fax:
Practice Address - Street 1:508 GRACE ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3046
Practice Address - Country:US
Practice Address - Phone:214-301-2974
Practice Address - Fax:972-923-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty