Provider Demographics
NPI:1225515984
Name:MEAD, MICHAEL TODD (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:MEAD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:TODD
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3624 KERN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0700
Mailing Address - Country:US
Mailing Address - Phone:469-486-0570
Mailing Address - Fax:
Practice Address - Street 1:3535 VICTORY GROUP WAY STE 500
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6727
Practice Address - Country:US
Practice Address - Phone:469-287-5502
Practice Address - Fax:972-294-5139
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional