Provider Demographics
NPI:1972676161
Name:IRWIN, PAUL C (MED LPC ,NCC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MED LPC ,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22603 MADISON PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2541
Mailing Address - Country:US
Mailing Address - Phone:210-497-0524
Mailing Address - Fax:210-497-0524
Practice Address - Street 1:22603 MADISON PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2541
Practice Address - Country:US
Practice Address - Phone:210-497-0524
Practice Address - Fax:210-497-0524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX02914902Medicaid