Basic Information
| Provider Information | |||||||||
| NPI: | 1689801664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL K. CHAFETZ, PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2132 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722589570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8340 MEADOW RD. #134 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752313769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692335566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | BILLMAN | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLAIMS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9722589570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 22365 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.