Individual
MS. NICOLE R MABRY
Active
Individual
MS. NICOLE R MABRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
65777
TX
103TC0700X
Clinical Psychologist
Primary
36997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36997
PHD
TX
01
—
65777
LPC LICENSE
TX
Enumeration date
08/10/2012
Last updated
12/10/2015
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