Individual
MICHAEL GLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
3906 LEMMON AVE STE 204, DALLAS, TX 75219-3760
(214) 521-0451
Mailing address
3906 LEMMON AVE STE 204, DALLAS, TX 75219-3760
(214) 521-0451
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2-1404
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096785301
—
TX
01
—
86070A
BCBS
TX
Enumeration date
09/01/2006
Last updated
09/15/2009
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