Provider Demographics
NPI:1598777443
Name:MCCOLLUM, PAUL STERLING (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STERLING
Last Name:MCCOLLUM
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 1:3510 N SAINT MARYS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3164
Mailing Address - Country:US
Mailing Address - Phone:210-733-1892
Mailing Address - Fax:210-733-5859
Practice Address - Street 1:3510 N SAINT MARYS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3164
Practice Address - Country:US
Practice Address - Phone:210-733-1892
Practice Address - Fax:210-733-5859
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20863103TC1900X
TX30176103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR55301Medicare UPIN
TX00N77RMedicare ID - Type UnspecifiedPSYCHOLOGICAL SERVICES