Provider Demographics
NPI:1235175985
Name:DITSKY, MICHAEL GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:DITSKY
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 1:2522 COOLING BREEZE DR.
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406
Mailing Address - Country:US
Mailing Address - Phone:281-770-0826
Mailing Address - Fax:281-656-6621
Practice Address - Street 1:7002 RIVER FRONT DR
Practice Address - Street 2:900A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-770-0826
Practice Address - Fax:281-656-6621
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34088103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01081201OtherCAPITAL BLUE CROSS
PA412766OtherPA BLUE SHIELD
PA611638OtherBC/BS OF MD. CARE FIRST
PA366298OtherVALUE OPTIONS
PA273439000OtherMAGELLAN
PA2249048OtherCIGNA BEHAVIORAL HEALTH
PA2249048OtherCIGNA BEHAVIORAL HEALTH
PA412766Medicare ID - Type Unspecified