Provider Demographics
NPI:1730139981
Name:VANDEHEY, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VANDEHEY
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 1:2211 MIDWESTERN PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2300
Mailing Address - Country:US
Mailing Address - Phone:940-692-9745
Mailing Address - Fax:940-692-9722
Practice Address - Street 1:2211 MIDWESTERN PKWY STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2300
Practice Address - Country:US
Practice Address - Phone:940-692-9745
Practice Address - Fax:940-692-9722
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31569103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147462901Medicaid