Provider Demographics
NPI:1427404557
Name:CAGLE, MARK STEPHEN JR (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:CAGLE
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 DESERET TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2324
Mailing Address - Country:US
Mailing Address - Phone:972-533-1788
Mailing Address - Fax:
Practice Address - Street 1:6060 N CENTRAL EXPY
Practice Address - Street 2:460
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5209
Practice Address - Country:US
Practice Address - Phone:972-533-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional