Provider Demographics
NPI:1811762917
Name:PILSITZ, MARY A (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:PILSITZ
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:MAREN
Other - Middle Name:
Other - Last Name:PILSITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LCDC
Mailing Address - Street 1:3555 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7610
Mailing Address - Country:US
Mailing Address - Phone:325-747-8033
Mailing Address - Fax:
Practice Address - Street 1:3555 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7610
Practice Address - Country:US
Practice Address - Phone:325-747-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12365101YA0400X
TX86145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)