Provider Demographics
NPI:1578634283
Name:ZAZECKIS, THOMAS MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:ZAZECKIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:M
Other - Last Name:ZAZECKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6602 BUFFALO HLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2330
Mailing Address - Country:US
Mailing Address - Phone:210-698-6075
Mailing Address - Fax:210-698-6075
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-671-2032
Practice Address - Fax:210-671-5700
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3117103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist