Organization
MICKY GAUTAM, D.O., P.A.
Active
Other names
Psych Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICKY KEYURNATH GAUTAM D.O. (OWNER/PRESIDENT)
(214) 223-9235
Entity
Organization
Contact information
Practice address
7808 CLODUS FIELDS DR, DALLAS, TX 75251-2206
(214) 223-9235
(817) 730-9080
Mailing address
PO BOX 561136, THE COLONY, TX 75056-6136
(214) 223-9235
(817) 730-9080
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
L1861
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L1861
TX LICENSE
TX
Enumeration date
12/19/2008
Last updated
07/25/2025
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