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General NPI Number Information
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NPI Number | 1063939692
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Entity Type | Organization
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Legal Business Name | HEALING MARRIAGE DALLAS
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 6333 DIAMOND HEAD CIR APT D
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City | DALLAS
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State | TX
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Zip | 75225-3411
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Country | US
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Telephone | 214-773-5645
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Fax | 214-571-4435
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Provider Business Mailing Address
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Address Line | 8216 RIDGELEA ST
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City | DALLAS
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State | TX
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Zip | 75209-2624
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Country | US
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Telephone | 214-773-5645
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Fax | 214-571-4435
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NESTOR PRESAS
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Credential | LMFT
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Telephone | 214-773-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202225
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License Number State | TX
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