Provider Demographics
NPI:1407206410
Name:FULLY LIVING COUNSELING PLLC
Entity Type:Organization
Organization Name:FULLY LIVING COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-310-4484
Mailing Address - Street 1:2901 CORPORATE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5625
Mailing Address - Country:US
Mailing Address - Phone:972-310-4484
Mailing Address - Fax:
Practice Address - Street 1:2901 CORPORATE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-5625
Practice Address - Country:US
Practice Address - Phone:972-310-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty