=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912232638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ROBERT FALKENSTINE LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2009
-----------------------------------------------------
Last Update Date | 09/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 LAMAR AVE
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-785-0400
-----------------------------------------------------
Fax | 903-785-0403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 442 PRIVATE ROAD 35451
-----------------------------------------------------
City | SUMNER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75486-5015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-741-3452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 82133
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------