Provider Demographics
NPI:1952353534
Name:DICKERSON, WINDEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:WINDEL
Middle Name:
Last Name:DICKERSON
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:BOX 629
Mailing Address - Street 2:
Mailing Address - City:COUPLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78615
Mailing Address - Country:US
Mailing Address - Phone:337-348-6691
Mailing Address - Fax:
Practice Address - Street 1:202 HOXIE
Practice Address - Street 2:
Practice Address - City:COUPLAND
Practice Address - State:TX
Practice Address - Zip Code:78615
Practice Address - Country:US
Practice Address - Phone:337-348-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87277AOtherBCBS
TXP00322224OtherRR MEDICARE
TX8G4659Medicare PIN