Provider Demographics
NPI:1598770323
Name:LUEPNITZ, ROY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:R
Last Name:LUEPNITZ
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 1:4444 CARTER CREEK PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4467
Mailing Address - Country:US
Mailing Address - Phone:979-260-6700
Mailing Address - Fax:979-260-3366
Practice Address - Street 1:4444 CARTER CREEK PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4467
Practice Address - Country:US
Practice Address - Phone:979-260-6700
Practice Address - Fax:979-260-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23467103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD20BMedicare ID - Type Unspecified