Provider Demographics
NPI:1295953289
Name:WAWRYKOW, GEORGE MICHAEL (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:WAWRYKOW
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. DRAWER 1389
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77383-1389
Mailing Address - Country:US
Mailing Address - Phone:281-353-4948
Mailing Address - Fax:281-353-4948
Practice Address - Street 1:21082 GREENGATE DRIVE
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3445
Practice Address - Country:US
Practice Address - Phone:281-382-9769
Practice Address - Fax:281-353-4948
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical