Maricon Revis, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

40278 Issued in TX

Practice address

4722 Taft Blvd Ste 2
Wichita Falls, TX 76308-4800

Phone

(940) 691-1899

Fax

(940) 691-3423

NPI assigned

Nov 15, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitality Clinical Services PLLC

  • Clinical Psychologist
  • Fort Worth, TX
  • NPI 1710750567
  Medicare reassignment
• Taft Counseling Center Inc

  • Counselor
  • Wichita Falls, TX
  • NPI 1922057769
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786665600000",
    "number": "1972847945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95-1001 KOOLANI DR APT F601",
            "city": "MILILANI",
            "state": "HI",
            "postal_code": "967896021",
            "telephone_number": "808-286-9115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 TAFT BLVD STE 2",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763084800",
            "telephone_number": "940-691-1899",
            "fax_number": "940-691-3423"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "95-1001 Koolani Dr Apt F601",
            "address_purpose": "LOCATION",
            "city": "Mililani",
            "state": "HI",
            "postal_code": "967896021",
            "country_code": "US",
            "telephone_number": "808-286-9115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVIS",
        "first_name": "MARICON",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "81717",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "40278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Raymond Reneau, MS,PT,OCS,ATC,LAT
• Jennifer Renner
• Lorna Liz Rentas, LCDC
• Paul N Renton Jr., M.D.
• Victoria Roxane Resendiz
• Leslie Michelle Reyes, B.S.
• Maggie Renee Veigl Reyes, OD
• Donna Lee Reynolds, MS ED; SPECIAL ED
• Lianna Reynolds, LPC
• RG Rheumatology Med PLLC

• Clinical Psychologist in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.