Provider Demographics
NPI:1962499814
Name:HUPP, GREGORY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:HUPP
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:PO BOX 2973
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-2973
Mailing Address - Country:US
Mailing Address - Phone:866-679-7901
Mailing Address - Fax:866-541-9162
Practice Address - Street 1:650 STATE HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3809
Practice Address - Country:US
Practice Address - Phone:866-679-7901
Practice Address - Fax:866-541-9162
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31593103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178235101Medicaid
TX0036MXOtherBCBS
TX0036MXOtherBCBS