Provider Demographics
NPI:1518907112
Name:SCHOUP, FAWZ E (PHD)
Entity Type:Individual
Prefix:MS
First Name:FAWZ
Middle Name:E
Last Name:SCHOUP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 NEW HOPE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076
Mailing Address - Country:US
Mailing Address - Phone:615-782-6047
Mailing Address - Fax:
Practice Address - Street 1:4213 NEW HOPE MEADOW RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-4710
Practice Address - Country:US
Practice Address - Phone:615-782-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3982578Medicare ID - Type UnspecifiedMEDICARE ID NUMBER