Individual
TIESHA MADDIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-6102
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-6102
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
592
WY
103TC0700X
Clinical Psychologist
Primary
596
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/12/2016
Last updated
03/22/2022
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