Healthcare Provider Details

I. General information

NPI: 1437444502
Provider Name (Legal Business Name): MICHELLE PARKIN HEPWORTH MAC, LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W JACKSON RD
CARROLLTON TX
75006-1316
US

IV. Provider business mailing address

1100 W JACKSON RD
CARROLLTON TX
75006-1316
US

V. Phone/Fax

Practice location:
  • Phone: 817-876-9824
  • Fax: 972-242-2932
Mailing address:
  • Phone: 817-876-9824
  • Fax: 972-242-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: