Provider Demographics
NPI:1447600432
Name:MEULMAN, JOHN-MARK (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JOHN-MARK
Middle Name:
Last Name:MEULMAN
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 HAMPSHIRE LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4306
Mailing Address - Country:US
Mailing Address - Phone:469-709-9502
Mailing Address - Fax:
Practice Address - Street 1:1113 HAMPSHIRE LN
Practice Address - Street 2:SUITE 3
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4306
Practice Address - Country:US
Practice Address - Phone:469-709-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120504101YA0400X
TX72067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)