Provider Demographics
NPI:1114278421
Name:DISMUKE EUDY, TORI (LPC)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:DISMUKE EUDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HIGHWAY 352 STE 100A
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6897
Mailing Address - Country:US
Mailing Address - Phone:214-642-9695
Mailing Address - Fax:
Practice Address - Street 1:701 HIGHWAY 352 STE A100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6897
Practice Address - Country:US
Practice Address - Phone:214-642-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69505101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional