Healthcare Provider Details

I. General information

NPI: 1235175985
Provider Name (Legal Business Name): MICHAEL GEORGE DITSKY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 RIVER FRONT DR 900A
SUGAR LAND TX
77479
US

IV. Provider business mailing address

2522 COOLING BREEZE DR.
RICHMOND TX
77406
US

V. Phone/Fax

Practice location:
  • Phone: 281-770-0826
  • Fax: 281-656-6621
Mailing address:
  • Phone: 281-770-0826
  • Fax: 281-656-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: