Provider Demographics
NPI:1366549677
Name:KOZAK, THOMAS MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KOZAK
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 1:1001 MEDICAL PLAZA DR.
Mailing Address - Street 2:SUITE 190
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3210
Mailing Address - Country:US
Mailing Address - Phone:281-367-0733
Mailing Address - Fax:281-298-1915
Practice Address - Street 1:1001 MEDICAL PLAZA DR.
Practice Address - Street 2:SUITE 190
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3210
Practice Address - Country:US
Practice Address - Phone:281-367-0733
Practice Address - Fax:281-298-1915
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4182103T00000X
MI6301004037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist