1053439091 NPI number — APRIL ELLEN MUCCIACCIARO M.ED., LMFTA

Table of content: APRIL ELLEN MUCCIACCIARO M.ED., LMFTA (NPI 1053439091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053439091 NPI number — APRIL ELLEN MUCCIACCIARO M.ED., LMFTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUCCIACCIARO
Provider First Name:
APRIL
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LMFTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAKELL
Provider Other First Name:
APRIL
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053439091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7125 HIGHWAY 67
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-572-5000
Provider Business Mailing Address Fax Number:
972-572-9448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7125 HIGHWAY 67
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-572-5000
Provider Business Practice Location Address Fax Number:
972-572-9448
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  201709 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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