Provider Demographics
NPI:1427229509
Name:WOMACK, MILTON (EDD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:WOMACK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23302 MEADOW CROSS LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2142
Mailing Address - Country:US
Mailing Address - Phone:281-395-5583
Mailing Address - Fax:
Practice Address - Street 1:23302 MEADOW CROSS LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2142
Practice Address - Country:US
Practice Address - Phone:281-395-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20904103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling