Provider Demographics
NPI:1467501403
Name:FALKSTEIN, DAVID LAWRENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:FALKSTEIN
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:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0010
Mailing Address - Country:US
Mailing Address - Phone:972-954-7188
Mailing Address - Fax:213-283-4252
Practice Address - Street 1:204 W MCDERMOTT DR STE A
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8058
Practice Address - Country:US
Practice Address - Phone:972-954-7188
Practice Address - Fax:214-383-4252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2017-08-24
Deactivation Date:2016-02-26
Deactivation Code:
Reactivation Date:2017-08-24
Provider Licenses
StateLicense IDTaxonomies
TX30682103T00000X
TX32077103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031582201Medicaid
TX031582201Medicaid
TX031582201Medicaid