MEDICARE: DR. MICHAEL C MESSINA PSY.D., BCBA-D

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	103TC0700X	Clinical Psychologist	36673	TX

General Provider Information

NPI Number	:	1902927924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C MESSINA PSY.D., BCBA-D

Provider Business Mailing Address
First Line	:	PO BOX 732973
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-2973
Country	:	US
Telephone Number	:	817-702-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4709
Country	:	US
Telephone Number	:	817-702-3100
Fax Number	:	817-702-4847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	10/10/2018

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