Individual
MRS. MARCIA MARLENE MONGHATE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
8059 SCYENE CIR, DALLAS, TX 75227-5562
(800) 257-8715
(800) 819-1655
Mailing address
1119 W RIDGE DR, DUNCANVILLE, TX 75116-3016
(972) 572-2949
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
418304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N9606
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/04/2006
Last updated
07/08/2007
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