Healthcare Provider Details

I. General information

NPI: 1093191165
Provider Name (Legal Business Name): MARSHALL BEWLEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W HICKORY ST STE 304
DENTON TX
76201-4151
US

IV. Provider business mailing address

207 W HICKORY ST STE 304
DENTON TX
76201-4151
US

V. Phone/Fax

Practice location:
  • Phone: 940-294-6789
  • Fax:
Mailing address:
  • Phone: 806-535-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: