MG Associates PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

TX214042 Issued in TX

Legal business name

MG ASSOCIATES PA

Practice address

3906 Lemmon Ave
Suite 204
Dallas, TX 75219-3760

Phone

(214) 521-0451

Fax

(214) 520-9261

NPI assigned

Nov 7, 2006

Last updated

Sep 15, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Allan Glick, EDDNPI 1801998703

Title

Licensed Psychologist

Phone

(214) 521-0451

Specialties & licenses 1

Addresses

Other names 1

• Professional Association Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Glick, EDD

  • Psychologist
  • Dallas, TX
  • NPI 1801998703
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1447329024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3906 LEMMON AVE",
            "address_2": "SUITE 204",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752193760",
            "telephone_number": "214-521-0451",
            "fax_number": "214-520-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3906 LEMMON AVE",
            "address_2": "SUITE 204",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752193760",
            "telephone_number": "214-521-0451",
            "fax_number": "214-520-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MG ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "GLICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "214-521-0451",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "TX214042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Association",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Psychologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.