Provider Demographics
NPI:1114487329
Name:PAUL L WARREN, PSYD, PC
Entity Type:Organization
Organization Name:PAUL L WARREN, PSYD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:817-292-4179
Mailing Address - Street 1:PO BOX 331584
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76163-1584
Mailing Address - Country:US
Mailing Address - Phone:817-292-4179
Mailing Address - Fax:817-918-4839
Practice Address - Street 1:5658 WESTCREEK DR STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-2254
Practice Address - Country:US
Practice Address - Phone:817-292-4179
Practice Address - Fax:817-918-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPT000U23XMedicaid