Provider Demographics
NPI:1871740290
Name:MASSEY, MIKEL JOSEPH (LCDC, CART)
Entity type:Individual
Prefix:MR
First Name:MIKEL
Middle Name:JOSEPH
Last Name:MASSEY
Suffix:
Gender:M
Credentials:LCDC, CART
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC, CART
Mailing Address - Street 1:9535 FOREST LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5900
Mailing Address - Country:US
Mailing Address - Phone:214-628-2688
Mailing Address - Fax:214-628-2699
Practice Address - Street 1:9535 FOREST LN
Practice Address - Street 2:SUITE 104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5900
Practice Address - Country:US
Practice Address - Phone:214-628-2688
Practice Address - Fax:214-628-2699
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10740101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)