Individual
DR. MARY ANN THAMARAVELIL GANSLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1700 WILDCAT DR, SUITE D, PORTLAND, TX 78374-2817
(361) 445-4080
(888) 413-3010
Mailing address
1019 FOREST OAK, PORTLAND, TX 78374-4153
(361) 425-2692
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
35139
TX
Other
Enumeration date
11/15/2011
Last updated
11/17/2011
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