Healthcare Provider Details

I. General information

NPI: 1841437126
Provider Name (Legal Business Name): MICHAEL JAY ECUYER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 FALCON RIDGE RD
DENTON TX
76208-1567
US

IV. Provider business mailing address

7809 FALCON RIDGE RD
DENTON TX
76208-1567
US

V. Phone/Fax

Practice location:
  • Phone: 225-266-7356
  • Fax:
Mailing address:
  • Phone: 225-266-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2745
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: