MEDICARE: MICHAEL D ASHENFELTER JR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	63230	TX

General Provider Information

NPI Number	:	1710251327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D ASHENFELTER JR

Provider Business Mailing Address
First Line	:	8555 FAIR OAKS XING
Second Line	:	510
City	:	DALLAS
State	:	TX
Zip	:	75243-8085
Country	:	US
Telephone Number	:	469-337-8363
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 LBJ FWY
Second Line	:	STE. 245
City	:	DALLAS
State	:	TX
Zip	:	75240-6514
Country	:	US
Telephone Number	:	469-337-8363
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL DEAN ASHENFELTER JR.
Credential	:	LPC
Telephone Number	:	469-337-8363

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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