Provider Demographics
NPI:1063952273
Name:WAXLER, DAVE (LPC)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:WAXLER
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 1:821 DRAGONFLY DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-5501
Mailing Address - Country:US
Mailing Address - Phone:936-443-6107
Mailing Address - Fax:
Practice Address - Street 1:821 DRAGONFLY DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-5501
Practice Address - Country:US
Practice Address - Phone:936-443-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional