Individual
MR. FREDERICK LYNN THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
3402 OAK GROVE AVE, SUITE NO. 305, DALLAS, TX 75204-2353
(214) 965-9104
Mailing address
10721 SANDALWOOD DR, DALLAS, TX 75228-2753
(214) 604-1042
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
68573
TX
101YM0800X
Mental Health Counselor
Primary
68573
TX
Other
Enumeration date
02/09/2014
Last updated
02/09/2014
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