Provider Demographics
NPI:1902227952
Name:NYSTEDT, GREGORY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:NYSTEDT
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 1:9950 CYPRESSWOOD DR
Mailing Address - Street 2:SUITE 227
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3414
Mailing Address - Country:US
Mailing Address - Phone:281-970-7926
Mailing Address - Fax:281-955-2913
Practice Address - Street 1:9950 CYPRESSWOOD DR
Practice Address - Street 2:SUITE 227
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3414
Practice Address - Country:US
Practice Address - Phone:281-970-7926
Practice Address - Fax:281-955-2913
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21558OtherLICENSE FROMTEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS