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General NPI Number Information
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NPI Number | 1427479955
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Entity Type | Organization
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Legal Business Name | MLDCJC INC
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 5415 N MCCOLL RD
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City | MCALLEN
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State | TX
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Zip | 78504-2206
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Country | US
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Telephone | 956-358-8370
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 N 21ST ST
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City | MCALLEN
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State | TX
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Zip | 78504-5649
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIEF EXECUTIVE OFFICER
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Name | DR. MARK L DANTZKER
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Credential | PH.D.
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Telephone | 956-358-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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