Provider Demographics
NPI:1568730273
Name:DAHL, AUDRA LYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:LYN
Last Name:DAHL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SW GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-3708
Mailing Address - Country:US
Mailing Address - Phone:817-704-6991
Mailing Address - Fax:817-701-0379
Practice Address - Street 1:2350 SW GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3708
Practice Address - Country:US
Practice Address - Phone:817-704-6991
Practice Address - Fax:817-701-0379
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional