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General NPI Number Information
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NPI Number | 1528857141
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Entity Type | Organization
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Legal Business Name | MICHELE MICK, PHD, PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 8231 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3356
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Country | US
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Telephone | 210-269-5254
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Fax |
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Provider Business Mailing Address
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Address Line | 538 DONALDSON AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78201-4846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MICHELE MICK
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Credential | PHD
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Telephone | 210-269-5254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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