Provider Demographics
NPI:1538642525
Name:BELLOWS, MARVIN DALE II (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:DALE
Last Name:BELLOWS
Suffix:II
Gender:M
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 SOUTHERN DR STE 461
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1533
Mailing Address - Country:US
Mailing Address - Phone:903-348-1661
Mailing Address - Fax:
Practice Address - Street 1:3256 SOUTHERN DR STE 461
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1533
Practice Address - Country:US
Practice Address - Phone:903-348-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional