MEDICARE: DR. PATRICIA JANE MICKLOS PSY.D.

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	103TC0700X	Clinical Psychologist	22596	TX
2	103TF0000X	Family Psychologist	001559-042699	TX

General Provider Information

NPI Number	:	1033110812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA JANE MICKLOS PSY.D.

Provider Business Mailing Address
First Line	:	900 AUSTIN AVE
Second Line	:	SUITE 500
City	:	WACO
State	:	TX
Zip	:	76701-1902
Country	:	US
Telephone Number	:	254-753-7444
Fax Number	:	254-714-1737

Provider Business Practice Location Address
First Line	:	900 AUSTIN AVE
Second Line	:	SUITE 500
City	:	WACO
State	:	TX
Zip	:	76701-1902
Country	:	US
Telephone Number	:	254-753-7444
Fax Number	:	254-714-1737

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	09/11/2025

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