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General NPI Number Information
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NPI Number | 1366722944
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Entity Type | Organization
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Legal Business Name | SELF AND ASSOCIATES
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 6130 RICHMOND AVE
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City | DALLAS
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State | TX
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Zip | 75214
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Country | US
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Telephone | 214-732-6121
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Fax | 214-827-4974
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Provider Business Mailing Address
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Address Line | 6130 RICHMOND AVE
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City | DALLAS
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State | TX
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Zip | 75214
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Country | US
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Telephone | 214-732-6121
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Fax | 214-827-4974
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. JAMES HERSHELL SELF
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Credential | LMFT
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Telephone | 214-732-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 16442
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License Number State | TX
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