Provider Demographics
NPI:1497567952
Name:TAKEN, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:TAKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3455
Mailing Address - Country:US
Mailing Address - Phone:214-263-0983
Mailing Address - Fax:
Practice Address - Street 1:11225 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3455
Practice Address - Country:US
Practice Address - Phone:214-263-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health