Provider Demographics
NPI:1649389883
Name:CUPPETT, PAUL RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:CUPPETT
Suffix:
Gender:M
Credentials:PSYD
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 174541
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-4541
Mailing Address - Country:US
Mailing Address - Phone:817-375-8890
Mailing Address - Fax:
Practice Address - Street 1:320 WESTWAY PL
Practice Address - Street 2:SUITE 547
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5245
Practice Address - Country:US
Practice Address - Phone:817-375-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1045223Medicare UPIN