Provider Demographics
NPI:1225301625
Name:DZIEDZIC, ADAM SCOTT (MA,)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:SCOTT
Last Name:DZIEDZIC
Suffix:
Gender:M
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22001 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7002
Mailing Address - Country:US
Mailing Address - Phone:832-595-7700
Mailing Address - Fax:
Practice Address - Street 1:22001 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:832-595-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1520103TC1900X
1520103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy