Provider Demographics
NPI:1629664305
Name:FRIEDMAN, MICHAEL BRODER (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRODER
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLLC
Mailing Address - Street 1:7015 JUDI ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6119
Mailing Address - Country:US
Mailing Address - Phone:972-896-0519
Mailing Address - Fax:
Practice Address - Street 1:7015 JUDI ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6119
Practice Address - Country:US
Practice Address - Phone:972-896-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health