Provider Demographics
NPI:1669518304
Name:DENNIS, MICHAEL PAUL (MSLPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MSLPC
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 10612
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0612
Mailing Address - Country:US
Mailing Address - Phone:254-289-0108
Mailing Address - Fax:254-793-4271
Practice Address - Street 1:602 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2323
Practice Address - Country:US
Practice Address - Phone:254-289-0108
Practice Address - Fax:254-793-4271
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional