Healthcare Provider Details

I. General information

NPI: 1225780703
Provider Name (Legal Business Name): CHRISTOPHER GLEN SEALS MS, LPC, LCDC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 WORTH ST
DALLAS TX
75246-1607
US

IV. Provider business mailing address

539 W COMMERCE ST # 2613
DALLAS TX
75208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 214-623-6830
  • Fax: 214-623-6807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16031
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: