Individual
M. THERESA EMERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
6609 SANGER AVE, WACO, TX 76710-4252
(254) 776-3632
(254) 776-8181
Mailing address
PO BOX 21594, WACO, TX 76702-1594
(254) 776-3632
(254) 776-8181
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
22851
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J50P
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/18/2005
Last updated
07/10/2012
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