Individual
ATHENA MASK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
2455 N EASTMAN RD, LONGVIEW, TX 75605-4057
(903) 315-9338
Mailing address
408 E SOUTH ST APT 2, KILGORE, TX 75662-2552
(903) 315-9338
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
14101
TX
Other
Enumeration date
02/24/2020
Last updated
02/24/2020
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