Provider Demographics
NPI:1376907444
Name:THANNIKKODAN KURIAKOSE, BINOY (MA LPC)
Entity Type:Individual
Prefix:
First Name:BINOY
Middle Name:
Last Name:THANNIKKODAN KURIAKOSE
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 1:600 E TAYLOR ST
Mailing Address - Street 2:SUITE 4011
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2881
Mailing Address - Country:US
Mailing Address - Phone:214-596-8486
Mailing Address - Fax:
Practice Address - Street 1:1414 SHILOH RD
Practice Address - Street 2:APT # 3711
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8257
Practice Address - Country:US
Practice Address - Phone:214-596-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional