Provider Demographics
NPI:1053973453
Name:RIEPL, MARK WILLIAM (MASTERS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:RIEPL
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19445 DAVID MEMORIAL DR
Mailing Address - Street 2:UNIT #1707
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385
Mailing Address - Country:US
Mailing Address - Phone:281-768-9603
Mailing Address - Fax:
Practice Address - Street 1:19445 DAVID MEMORIAL DR
Practice Address - Street 2:UNIT #1707
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:281-768-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician