Provider Demographics
NPI:1619099736
Name:WIRTZ, R PAUL (MA)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:PAUL
Last Name:WIRTZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3881
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3881
Mailing Address - Country:US
Mailing Address - Phone:806-477-4951
Mailing Address - Fax:806-477-5678
Practice Address - Street 1:HYW 60 AT FM 2373
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79120-0020
Practice Address - Country:US
Practice Address - Phone:806-477-4951
Practice Address - Fax:806-477-5678
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist