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General NPI Number Information
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NPI Number | 1700122496
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Entity Type | Organization
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Legal Business Name | WENDY M EZELL
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 5210 MCKINNEY AVE # 225
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City | DALLAS
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State | TX
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Zip | 75205-3357
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Country | US
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Telephone | 214-498-1513
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 MCKINNEY AVE # 225
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City | DALLAS
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State | TX
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Zip | 75205-3357
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Country | US
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Telephone | 214-498-1513
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | WENDY EZELL
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Credential | LPC
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Telephone | 214-498-1513
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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 | 66405
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License Number State | TX
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