Provider Demographics
NPI:1013118116
Name:BIRD, MARK H (LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:BIRD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HEBRON PKWY STE 1102
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5146
Mailing Address - Country:US
Mailing Address - Phone:214-562-9317
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY STE 1102
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5146
Practice Address - Country:US
Practice Address - Phone:214-562-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist