Provider Demographics
NPI:1356615223
Name:HETZEL, RODERICK DAVIS (PHD)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:DAVIS
Last Name:HETZEL
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 1:215 S 2ND ST STE 303
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-2216
Mailing Address - Country:US
Mailing Address - Phone:254-424-9117
Mailing Address - Fax:
Practice Address - Street 1:215 S 2ND ST STE 303
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2216
Practice Address - Country:US
Practice Address - Phone:254-424-9117
Practice Address - Fax:254-294-2174
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical