Healthcare Provider Details

I. General information

NPI: 1033110812
Provider Name (Legal Business Name): PATRICIA JANE MICKLOS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 AUSTIN AVE SUITE 500
WACO TX
76701-1902
US

IV. Provider business mailing address

900 AUSTIN AVE SUITE 500
WACO TX
76701-1902
US

V. Phone/Fax

Practice location:
  • Phone: 254-753-7444
  • Fax: 254-714-1737
Mailing address:
  • Phone: 254-753-7444
  • Fax: 254-714-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22596
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number001559-042699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: