Provider Demographics
NPI:1215662754
Name:DEAL, MARQUE DEMOND
Entity type:Individual
Prefix:
First Name:MARQUE
Middle Name:DEMOND
Last Name:DEAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 BRENTWOOD STAIR RD STE 404
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1731
Mailing Address - Country:US
Mailing Address - Phone:817-492-9383
Mailing Address - Fax:
Practice Address - Street 1:1818 CORSICANA ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-6102
Practice Address - Country:US
Practice Address - Phone:214-670-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10736101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10736OtherCOUNSELING