Provider Demographics
NPI:1689801664
Name:PAUL K. CHAFETZ, PH.D
Entity Type:Organization
Organization Name:PAUL K. CHAFETZ, PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-258-9570
Mailing Address - Street 1:PO BOX 2132
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8132
Mailing Address - Country:US
Mailing Address - Phone:972-258-9570
Mailing Address - Fax:
Practice Address - Street 1:8340 MEADOW RD. #134
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3769
Practice Address - Country:US
Practice Address - Phone:469-233-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty