Provider Demographics
NPI:1558669242
Name:MAXWELL, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 GEMSTONE TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4465
Mailing Address - Country:US
Mailing Address - Phone:817-375-3934
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREENVILLE AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-6707
Practice Address - Country:US
Practice Address - Phone:972-375-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional