Provider Demographics
NPI:1679673172
Name:DZIUK, PATRICIA ELLEY (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEY
Last Name:DZIUK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 SAN GABRIEL ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3500
Mailing Address - Country:US
Mailing Address - Phone:512-478-5900
Mailing Address - Fax:512-328-8707
Practice Address - Street 1:2905 SAN GABRIEL ST
Practice Address - Street 2:SUITE 215
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3500
Practice Address - Country:US
Practice Address - Phone:512-478-5900
Practice Address - Fax:512-328-8707
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25353103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00032AJ3Medicaid
TX0032AJMedicare ID - Type Unspecified