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General NPI Number Information
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NPI Number | 1801998703
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Entity Type | Individual
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Provider Name | MICHAEL GLICK EDD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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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 STE 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 |
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Provider Business Mailing Address
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Address Line | 3906 LEMMON AVE STE 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 |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2-1404
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License Number State | TX
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