Healthcare Provider Details

I. General information

NPI: 1598770323
Provider Name (Legal Business Name): ROY R LUEPNITZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 CARTER CREEK PKWY SUITE 204
BRYAN TX
77802-4467
US

IV. Provider business mailing address

4444 CARTER CREEK PKWY SUITE 204
BRYAN TX
77802-4467
US

V. Phone/Fax

Practice location:
  • Phone: 979-260-6700
  • Fax: 979-260-3366
Mailing address:
  • Phone: 979-260-6700
  • Fax: 979-260-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number23467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: