Provider Demographics
NPI:1124847959
Name:M2JC PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:M2JC PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FARJELLAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-844-7028
Mailing Address - Street 1:8103 PURPLE ASTER PASS
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-2294
Mailing Address - Country:US
Mailing Address - Phone:210-844-7028
Mailing Address - Fax:
Practice Address - Street 1:8103 PURPLE ASTER PASS
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-2294
Practice Address - Country:US
Practice Address - Phone:210-844-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health