Provider Demographics
NPI:1770637340
Name:CHERRY, PAUL DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:CHERRY
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 1:3635 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1675
Mailing Address - Country:US
Mailing Address - Phone:972-278-4669
Mailing Address - Fax:972-278-2521
Practice Address - Street 1:3635 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1675
Practice Address - Country:US
Practice Address - Phone:972-278-4669
Practice Address - Fax:972-278-2521
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22201PSYCHOLOGIST103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR78867Medicare ID - Type Unspecified
TX00303RMedicare ID - Type Unspecified