| Doctor Name: | DR. PATRICIA JANE MICKLOS |
| NPI Number: | 1033110812 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 22596 |
| Business Practice Address: | 900 Austin Ave Suite 500 Waco, TX - 767011902 |
| Business Phone Number: | 2547537444 |
| Business Fax Number: | 2547141737 |
| Mailing Address: | 900 Austin Ave, Suite 500 WACO |
| State: | TX |
| Postal Code: | 767011902 |
| Phone Number: | 2547537444 |
| Fax Number: | 2547141737 |
| NPI Enumeration Date: | 08/03/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 22596 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |