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General NPI Number Information
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NPI Number | 1003191594
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Entity Type | Organization
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Legal Business Name | GREG HUPP, PH.D., PC
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Dates
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Enumeration Date | 10/15/2011
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Last Update Date | 10/15/2011
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Provider Practice Location Address
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Address Line | 650 STATE HWY 16 SO.
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City | BANDERA
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State | TX
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Zip | 78003
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Country | US
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Telephone | 830-796-7719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2973
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City | BANDERA
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State | TX
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Zip | 78003-2973
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. GREG HUPP
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Credential | PHD
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Telephone | 512-417-8538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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