Provider Demographics
NPI:1750476495
Name:HOUTZ, ANDREW W (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:HOUTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 205
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6606
Mailing Address - Country:US
Mailing Address - Phone:817-267-6290
Mailing Address - Fax:817-267-0950
Practice Address - Street 1:1305 AIRPORT FWY STE 205
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6606
Practice Address - Country:US
Practice Address - Phone:817-267-6290
Practice Address - Fax:817-267-0950
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX24431103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24431OtherTEXAS LICENSE