MEDICARE: DALLAS THERAPY CENTER

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	106H00000X	Marriage & Family Therapist
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1750983334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS THERAPY CENTER

Provider Business Mailing Address
First Line	:	1809 WESTLAKE DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-8507
Country	:	US
Telephone Number	:	972-233-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CEDAR SPRINGS RD STE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-7873
Country	:	US
Telephone Number	:	972-233-6800
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. LISA EGAN
Credential	:	LPCS
Telephone Number	:	972-233-6800

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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Directions to “DALLAS THERAPY CENTER ” Practice Location

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