Provider Demographics
NPI:1710269055
Name:SELF AND ASSOCIATES
Entity Type:Organization
Organization Name:SELF AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HERSHELL
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:214-732-6121
Mailing Address - Street 1:6130 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214
Mailing Address - Country:US
Mailing Address - Phone:214-732-6121
Mailing Address - Fax:214-827-4974
Practice Address - Street 1:6130 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:214-732-6121
Practice Address - Fax:214-827-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty