Healthcare Provider Details

I. General information

NPI: 1750314043
Provider Name (Legal Business Name): MARY B FETZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY B FETZER ED.D

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FROSTWOOD DR STE 258
HOUSTON TX
77024-2309
US

IV. Provider business mailing address

909 FROSTWOOD DR STE 258
HOUSTON TX
77024-2309
US

V. Phone/Fax

Practice location:
  • Phone: 713-465-7076
  • Fax: 281-591-7459
Mailing address:
  • Phone: 713-465-7076
  • Fax: 281-591-7459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number23840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: