Provider Demographics
NPI:1396824314
Name:REASONER, MARY LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNN
Last Name:REASONER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 RICHMOND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3000
Mailing Address - Country:US
Mailing Address - Phone:713-681-9598
Mailing Address - Fax:713-524-5849
Practice Address - Street 1:3100 RICHMOND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3000
Practice Address - Country:US
Practice Address - Phone:713-681-9598
Practice Address - Fax:713-524-5849
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS52XMedicare ID - Type Unspecified