| Professional Association | |
|
3906 Lemmon Ave Suite 204 Dallas TX 75219-3760 | |
| (214) 521-0451 | |
| (214) 520-9261 |
| Full Name | Professional Association |
|---|---|
| Speciality | Psychologist |
| Location | 3906 Lemmon Ave, Dallas, Texas |
| Authorized Official Name and Position | Michael Allan Glick (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 2145210451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Association 3906 Lemmon Ave Suite 204 Dallas TX 75219-3760 Ph: (214) 521-0451 | Professional Association 3906 Lemmon Ave Suite 204 Dallas TX 75219-3760 Ph: (214) 521-0451 |
| NPI Number | 1447329024 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 09/15/2009 |
| Medicare PECOS PAC ID | 3173680766 |
|---|---|
| Medicare Enrollment ID | O20090326000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447329024 | NPI | - | NPPES |
| 096785304 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | TX214042 (Texas) | Primary |
| Provider Name | Michael A Glick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801998703 PECOS PAC ID: 7113084708 Enrollment ID: I20090326000149 |
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