Provider Demographics
NPI:1194587212
Name:SPECHT, ANTONIO DEVON SR (PSYD)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DEVON
Last Name:SPECHT
Suffix:SR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 DYER CREEK PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7900
Mailing Address - Country:US
Mailing Address - Phone:254-630-3388
Mailing Address - Fax:
Practice Address - Street 1:1015 DYER CREEK PL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-7900
Practice Address - Country:US
Practice Address - Phone:254-630-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS991403103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling