Provider Demographics
NPI:1447366810
Name:KATZ, CLIFFORD A (PHD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:A
Last Name:KATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10609 PORTRUSH CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1465
Mailing Address - Country:US
Mailing Address - Phone:512-680-8449
Mailing Address - Fax:
Practice Address - Street 1:10609 PORTRUSH CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-1465
Practice Address - Country:US
Practice Address - Phone:512-680-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87951223G0001X
TX22482103TC0700X
TX2-2482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1223G0001XDental ProvidersDentistGeneral Practice
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451977Medicare ID - Type Unspecified