Provider Demographics
NPI:1285895474
Name:MICHAEL, RICHARD G (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:SUITE 49
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-453-7879
Mailing Address - Fax:
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:SUITE 49
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-453-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical