Provider Demographics
NPI:1114923992
Name:MONROE, MARK M (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:M
Last Name:MONROE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6815
Mailing Address - Country:US
Mailing Address - Phone:512-431-2191
Mailing Address - Fax:512-458-1234
Practice Address - Street 1:8727 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6815
Practice Address - Country:US
Practice Address - Phone:512-431-2191
Practice Address - Fax:512-458-1234
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health