Provider Demographics
NPI:1134331176
Name:GROAT, MICHAEL D (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:GROAT
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 1:12301 MAIN STREET
Mailing Address - Street 2:PROFESSIONALS IN CRISIS PROGRAM
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2503
Mailing Address - Country:US
Mailing Address - Phone:713-275-5223
Mailing Address - Fax:713-275-5240
Practice Address - Street 1:12301 MAIN ST
Practice Address - Street 2:PROFESSIONALS IN CRISIS PROGRAM
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5502
Practice Address - Country:US
Practice Address - Phone:713-275-5223
Practice Address - Fax:713-275-5017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34042103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical