Provider Demographics
NPI:1043504582
Name:BITTLE, MARY (LMFTA, PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BITTLE
Suffix:
Gender:F
Credentials:LMFTA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 WINGATE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2824
Mailing Address - Country:US
Mailing Address - Phone:972-466-2677
Mailing Address - Fax:
Practice Address - Street 1:3709 WINGATE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2824
Practice Address - Country:US
Practice Address - Phone:972-466-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist