Provider Demographics
NPI:1912232638
Name:FALKENSTINE, MARK ROBERT (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:FALKENSTINE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 PRIVATE ROAD 35451
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:TX
Mailing Address - Zip Code:75486-5015
Mailing Address - Country:US
Mailing Address - Phone:972-741-3452
Mailing Address - Fax:
Practice Address - Street 1:737 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4479
Practice Address - Country:US
Practice Address - Phone:903-785-0400
Practice Address - Fax:903-785-0403
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673892OtherMEDICARE RHC NUMBER