Individual
DR. MICHAEL DAVID PENTICUFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1707 ENFIELD RD, AUSTIN, TX 78703-3308
(512) 454-9300
(512) 454-9370
Mailing address
1707 ENFIELD RD, AUSTIN, TX 78703-3308
(512) 454-9300
(512) 454-9370
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2-5038
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0362865-01
—
TX
Enumeration date
04/20/2006
Last updated
08/04/2015
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