MEDICARE: ANDREW W HOUTZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	24431	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24431	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1750476495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW W HOUTZ PHD

Provider Business Mailing Address
First Line	:	1305 AIRPORT FWY STE 205
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-6606
Country	:	US
Telephone Number	:	817-267-6290
Fax Number	:	817-267-0950

Provider Business Practice Location Address
First Line	:	1305 AIRPORT FWY STE 205
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-6606
Country	:	US
Telephone Number	:	817-267-6290
Fax Number	:	817-267-0950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/17/2018

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