Provider Demographics
NPI:1841659679
Name:AYOOB, MICHAEL LOUIS (EDD, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:AYOOB
Suffix:
Gender:M
Credentials:EDD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 VELASCO AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6329
Mailing Address - Country:US
Mailing Address - Phone:214-797-1164
Mailing Address - Fax:
Practice Address - Street 1:3200 SOUTHERN DR STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1549
Practice Address - Country:US
Practice Address - Phone:972-271-4300
Practice Address - Fax:972-271-4302
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1920101YP2500X
TX296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist