Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2853 | TX |
NPI | 1104062504 |
---|---|
Provider Name | Dr. Douglas Tim Fitzgerald |
First Address | Sugar Land, TX 77479-6535 |
Second Address | Sugar Land, TX 77479-6535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2009 |
Last Update Date | 06/01/2009 |