Provider Demographics
NPI:1316310444
Name:FESENBEK, MICHELE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:FESENBEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1027
Mailing Address - Country:US
Mailing Address - Phone:214-923-4598
Mailing Address - Fax:
Practice Address - Street 1:6675 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5573
Practice Address - Country:US
Practice Address - Phone:214-923-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70386OtherLICENSED PROFESSIONAL COUNSELOR