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General NPI Number Information
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NPI Number | 1447329024
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Entity Type | Organization
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Legal Business Name | MG ASSOCIATES PA
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 3906 LEMMON AVE SUITE 204
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City | DALLAS
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State | TX
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Zip | 75219-3760
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Country | US
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Telephone | 214-521-0451
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Fax | 214-520-9261
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Provider Business Mailing Address
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Address Line | 3906 LEMMON AVE SUITE 204
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City | DALLAS
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State | TX
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Zip | 75219-3760
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Country | US
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Telephone | 214-521-0451
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Fax | 214-520-9261
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MICHAEL ALLAN GLICK
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Credential | EDD
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Telephone | 214-521-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | TX214042
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License Number State | TX
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