Provider Demographics
NPI:1962062018
Name:WINTERS, MICHAEL RALPH (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RALPH
Last Name:WINTERS
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 1:3435 BRANARD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6031
Mailing Address - Country:US
Mailing Address - Phone:713-724-4622
Mailing Address - Fax:
Practice Address - Street 1:3435 BRANARD ST STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6031
Practice Address - Country:US
Practice Address - Phone:713-724-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist