Provider Demographics
NPI:1922295724
Name:FRESQUES, MICHAEL THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:FRESQUES
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 1:3355 BEE CAVE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6775
Mailing Address - Country:US
Mailing Address - Phone:512-327-6441
Mailing Address - Fax:512-327-8797
Practice Address - Street 1:3355 BEE CAVE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6775
Practice Address - Country:US
Practice Address - Phone:512-327-6441
Practice Address - Fax:512-327-8797
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24531103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist