Provider Demographics
NPI:1083732838
Name:ELDERPSYCH CARE PLLC
Entity Type:Organization
Organization Name:ELDERPSYCH CARE PLLC
Other - Org Name:SENIOR INSIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-542-7200
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:1007 W. HIGHWAY 190
Practice Address - Street 2:STE B
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3886
Practice Address - Country:US
Practice Address - Phone:254-542-7200
Practice Address - Fax:866-602-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX3-1593103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087QAOtherBCBS
TX188410801Medicaid
TX0087QAOtherBCBS