Healthcare Provider Details

I. General information

NPI: 1891096947
Provider Name (Legal Business Name): HAROLD FELDMAN MFLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NASH ST
ROCKWALL TX
75087-2204
US

IV. Provider business mailing address

831 NASH ST
ROCKWALL TX
75087-2204
US

V. Phone/Fax

Practice location:
  • Phone: 972-207-8414
  • Fax:
Mailing address:
  • Phone: 972-207-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5195
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: