Healthcare Provider Details

I. General information

NPI: 1699167700
Provider Name (Legal Business Name): DALLAS INTEGRATIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17734 PRESTON RD 200
DALLAS TX
75252
US

IV. Provider business mailing address

17734 PRESTON RD 200
DALLAS TX
75252-5684
US

V. Phone/Fax

Practice location:
  • Phone: 469-623-7100
  • Fax:
Mailing address:
  • Phone: 469-623-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number69886
License Number StateTX

VIII. Authorized Official

Name: LINDSAY HOLLMULLER
Title or Position: OWNER
Credential: LPC
Phone: 469-623-7100