Provider Demographics
NPI:1033129747
Name:CHAFETZ, PAUL K (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:CHAFETZ
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:PO BOX 92878
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-470-6676
Mailing Address - Fax:541-637-0298
Practice Address - Street 1:8340 MEADOW RD STE 134
Practice Address - Street 2:#134
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:469-233-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX620001485OtherMEDICARE RAILROAD
TX00SD78OtherBLUE CROSS BLUE SHIELD
TX035835001Medicaid
TX613850Medicare PIN