Provider Demographics
NPI:1003119769
Name:WEBB, MICHAEL DAVID (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:WEBB
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 SANGERS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9119
Mailing Address - Country:US
Mailing Address - Phone:817-791-5703
Mailing Address - Fax:
Practice Address - Street 1:1858 KELLER PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3757
Practice Address - Country:US
Practice Address - Phone:817-791-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9838101YA0400X
TX63885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)