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General NPI Number Information
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NPI Number | 1043229123
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Entity Type | Individual
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Provider Name | MARK H. FUGIT PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2006
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 17110 NORTH DALLAS PARKWAY SUITE 222
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City | DALLAS
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State | TX
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Zip | 75248-1915
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Country | US
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Telephone | 972-267-2642
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Fax | 972-267-2586
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Provider Business Mailing Address
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Address Line | 17110 NORTH DALLAS PARKWAY SUITE 222
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City | DALLAS
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State | TX
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Zip | 75248-1915
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Country | US
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Telephone | 972-267-2642
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Fax | 972-267-2586
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 24462
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License Number State | TX
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