MEDICARE: DR. MICHAEL VANDEHEY 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	103T00000X	Psychologist	31569	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730139981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL VANDEHEY PHD

Provider Business Mailing Address
First Line	:	2211 MIDWESTERN PKWY STE 2
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2300
Country	:	US
Telephone Number	:	940-692-9745
Fax Number	:	940-692-9722

Provider Business Practice Location Address
First Line	:	2211 MIDWESTERN PKWY STE 2
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2300
Country	:	US
Telephone Number	:	940-692-9745
Fax Number	:	940-692-9722

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/04/2022

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