Healthcare Provider Details

I. General information

NPI: 1245825470
Provider Name (Legal Business Name): MARCELLA ANN SYKORA LPC-A, ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 N COLLINS BLVD STE 411
RICHARDSON TX
75080-2665
US

IV. Provider business mailing address

2208 WINONA DR
PLANO TX
75074-2769
US

V. Phone/Fax

Practice location:
  • Phone: 972-544-6633
  • Fax:
Mailing address:
  • Phone: 562-472-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: