Provider Demographics
NPI:1063596005
Name:EMICK, MICHELLE A (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:EMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2852
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-2852
Mailing Address - Country:US
Mailing Address - Phone:940-591-9550
Mailing Address - Fax:940-591-9555
Practice Address - Street 1:1332 TEASLEY LN
Practice Address - Street 2:STE 177
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7946
Practice Address - Country:US
Practice Address - Phone:940-591-9550
Practice Address - Fax:940-591-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30727103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040685202Medicaid
TXS76514Medicare UPIN
TX00348PMedicare ID - Type Unspecified