Provider Demographics
NPI:1487760781
Name:BERRY, MARILU PRICE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILU
Middle Name:PRICE
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESLAYAN ST
Mailing Address - Street 2:SUITE 485
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5132
Mailing Address - Country:US
Mailing Address - Phone:713-439-1717
Mailing Address - Fax:713-621-2938
Practice Address - Street 1:2900 WESLAYAN ST
Practice Address - Street 2:SUITE 485
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5132
Practice Address - Country:US
Practice Address - Phone:713-439-1717
Practice Address - Fax:713-621-2938
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX91MROtherBLUE CROSS BLUE SHIELD
TX611980Medicare ID - Type Unspecified