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General NPI Number Information
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NPI Number | 1801290895
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Entity Type | Organization
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Legal Business Name | MARK E. HUNDLEY, PLLC
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 411 N. 16TH ST.
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City | MEMPHIS
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State | TX
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Zip | 79245
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Country | US
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Telephone | 469-422-1638
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Fax |
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Provider Business Mailing Address
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Address Line | 411 NORTH 16TH ST.
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City | MEMPHIS
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State | TX
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Zip | 79245
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Country | US
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Telephone | 469-422-1638
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK HUNDLEY
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Credential | M.ED. LPC-S
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Telephone | 469-422-1638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12615
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License Number State | TX
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