Provider Demographics
NPI:1851449326
Name:DALAL, MARK (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DALAL
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 1:6310 LBJ FWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6401
Mailing Address - Country:US
Mailing Address - Phone:214-668-6037
Mailing Address - Fax:
Practice Address - Street 1:6310 LBJ FWY
Practice Address - Street 2:SUITE 203
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6401
Practice Address - Country:US
Practice Address - Phone:214-668-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical