Provider Demographics
NPI:1922544113
Name:JAFARZADEH, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:JAFARZADEH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 MAIN ST
Mailing Address - Street 2:STE. 320
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4014
Mailing Address - Country:US
Mailing Address - Phone:214-760-1964
Mailing Address - Fax:214-760-9505
Practice Address - Street 1:1412 MAIN ST
Practice Address - Street 2:STE. 320
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202
Practice Address - Country:US
Practice Address - Phone:214-760-1964
Practice Address - Fax:214-760-9505
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37515103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist