Provider Demographics
NPI:1083323877
Name:MAIWALD, MARSHAL DILLON MARTIN (LMFT ASSOCIATE)
Entity Type:Individual
Prefix:MR
First Name:MARSHAL
Middle Name:DILLON MARTIN
Last Name:MAIWALD
Suffix:
Gender:M
Credentials:LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5940
Mailing Address - Country:US
Mailing Address - Phone:703-789-1579
Mailing Address - Fax:
Practice Address - Street 1:1121 DALLAS DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-5100
Practice Address - Country:US
Practice Address - Phone:940-483-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist