Provider Demographics
NPI:1760521165
Name:DEITCH, MICHAEL BRUCE (PHD LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:DEITCH
Suffix:
Gender:M
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 NEW TRAILS DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4253
Mailing Address - Country:US
Mailing Address - Phone:281-367-1015
Mailing Address - Fax:281-367-1966
Practice Address - Street 1:8701 NEW TRAILS DR
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4253
Practice Address - Country:US
Practice Address - Phone:281-367-1015
Practice Address - Fax:281-367-1966
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 9354101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6511LCOtherBLUE CROSS