Provider Demographics
NPI:1376633545
Name:DOWNING, MICHAEL DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:DOWNING
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:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79721-0947
Mailing Address - Country:US
Mailing Address - Phone:432-263-3868
Mailing Address - Fax:432-263-3402
Practice Address - Street 1:500 JOHNSON ST.
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2644
Practice Address - Country:US
Practice Address - Phone:432-263-3868
Practice Address - Fax:432-263-3402
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1133134 01Medicaid
TX00295EMedicare ID - Type Unspecified