1568517522 NPI number — DR. MICHAEL VINCENT DWYER EDD, LCMHC, LCPS

Table of content: DR. MICHAEL VINCENT DWYER EDD, LCMHC, LCPS (NPI 1568517522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568517522 NPI number — DR. MICHAEL VINCENT DWYER EDD, LCMHC, LCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DWYER
Provider First Name:
MICHAEL
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD, LCMHC, LCPS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DWYER
Provider Other First Name:
MIKE
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
EDD, LPC-S, LCMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568517522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 RAINBOW DR # 939
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77399-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-410-5552
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2474 PRINCETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARKSDALE AIR FORCE BASE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-410-5552
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

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: 101YA0400X , with the licence number:  125924 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 11206 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: EL11259 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 8997 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CC4401 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: MH8348 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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