Provider Demographics
NPI:1407999071
Name:VARDELL, MARK S (MA, LPC, LMFT, LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:VARDELL
Suffix:
Gender:M
Credentials:MA, LPC, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 RAMBLER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2321
Mailing Address - Country:US
Mailing Address - Phone:214-893-9927
Mailing Address - Fax:214-265-6501
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2321
Practice Address - Country:US
Practice Address - Phone:214-893-9927
Practice Address - Fax:214-265-6501
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5362101YA0400X
TX8819101YP2500X
TX002140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist