Provider Demographics
NPI:1295051217
Name:MICHALICA, MARK (LPC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MICHALICA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-2011
Mailing Address - Country:US
Mailing Address - Phone:940-484-6275
Mailing Address - Fax:
Practice Address - Street 1:215 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-2011
Practice Address - Country:US
Practice Address - Phone:940-484-6275
Practice Address - Fax:940-312-7888
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional