Provider Demographics
NPI:1174672836
Name:DAVID L. FALKSTEIN, PH.D., L.L.C.
Entity Type:Organization
Organization Name:DAVID L. FALKSTEIN, PH.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:FALKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-954-7188
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0010
Mailing Address - Country:US
Mailing Address - Phone:972-954-7188
Mailing Address - Fax:
Practice Address - Street 1:204 W MCDERMOTT DR
Practice Address - Street 2:SUITE A
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8058
Practice Address - Country:US
Practice Address - Phone:972-954-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031582201Medicaid