Provider Demographics
NPI:1528215449
Name:MARSHALL, FAYTEEN HOLMAN (LPC,LMFT)
Entity Type:Individual
Prefix:
First Name:FAYTEEN
Middle Name:HOLMAN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 SAN MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3113
Mailing Address - Country:US
Mailing Address - Phone:214-202-9590
Mailing Address - Fax:214-660-7911
Practice Address - Street 1:6220 GASTON AVE
Practice Address - Street 2:SUITE #501
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4329
Practice Address - Country:US
Practice Address - Phone:214-202-9590
Practice Address - Fax:214-660-7911
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8328101YP2500X
TX1356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist