Healthcare Provider Details

I. General information

NPI: 1356166300
Provider Name (Legal Business Name): STEPHEN PAUL CASE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SPEIGHT AVE
WACO TX
76706-1507
US

IV. Provider business mailing address

8206 WOODCREEK DR
WOODWAY TX
76712-3509
US

V. Phone/Fax

Practice location:
  • Phone: 254-710-2467
  • Fax:
Mailing address:
  • Phone: 979-492-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: