Provider Demographics
NPI:1790841526
Name:RICHTER, CARL X (PSYD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:X
Last Name:RICHTER
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 1:10615 PERRIN BEITEL RD
Mailing Address - Street 2:702
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3138
Mailing Address - Country:US
Mailing Address - Phone:210-656-3400
Mailing Address - Fax:210-656-5227
Practice Address - Street 1:10615 PERRIN BEITEL RD
Practice Address - Street 2:702
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3138
Practice Address - Country:US
Practice Address - Phone:210-656-3400
Practice Address - Fax:210-656-5227
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30887103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP12119Medicare UPIN
TX00980EMedicare ID - Type Unspecified