Healthcare Provider Details

I. General information

NPI: 1689704629
Provider Name (Legal Business Name): MICHAL KIDRON PHD, LPC, NCC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 LEMMON AVE SUITE 200
DALLAS TX
75219-2145
US

IV. Provider business mailing address

4517 JENNING DR
PLANO TX
75093-5507
US

V. Phone/Fax

Practice location:
  • Phone: 214-526-4525
  • Fax: 214-520-6468
Mailing address:
  • Phone: 972-758-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: