Provider Demographics
NPI:1447391891
Name:MOTZ, GERALD P (PHD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:P
Last Name:MOTZ
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 1:24891 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-7747
Mailing Address - Country:US
Mailing Address - Phone:713-869-8552
Mailing Address - Fax:713-869-8564
Practice Address - Street 1:24891 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-7747
Practice Address - Country:US
Practice Address - Phone:713-869-8552
Practice Address - Fax:713-869-8564
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0392474-01Medicaid
TX260033127OtherRR MEDICARE
TX81887POtherBCBS
TX81887PMedicare PIN