Provider Demographics
NPI:1649343252
Name:MINNICK, DONALD (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:MINNICK
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 1:17555 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3031
Mailing Address - Country:US
Mailing Address - Phone:281-480-7554
Mailing Address - Fax:281-480-4641
Practice Address - Street 1:17555 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3031
Practice Address - Country:US
Practice Address - Phone:281-480-7554
Practice Address - Fax:281-480-4641
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist