Healthcare Provider Details

I. General information

NPI: 1427376979
Provider Name (Legal Business Name): MICHELLE M DEAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4426
US

IV. Provider business mailing address

PO BOX 975341
DALLAS TX
75397-5341
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-7355
  • Fax: 214-345-2682
Mailing address:
  • Phone: 972-791-1224
  • Fax: 972-819-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number42424
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: