Provider Demographics
NPI:1619455144
Name:FALCO, MICHELLE VANESSA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VANESSA
Last Name:FALCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 N CENTRAL EXPY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2264
Mailing Address - Country:US
Mailing Address - Phone:214-934-1682
Mailing Address - Fax:
Practice Address - Street 1:10440 N CENTRAL EXPY STE 911
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2221
Practice Address - Country:US
Practice Address - Phone:214-934-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty