=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487868543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHSPRING, P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 03/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3115 LOOP 306 SUITE 110
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76904-5983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-942-1952
-----------------------------------------------------
Fax | 325-942-1517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3115 LOOP 306 SUITE 110
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76904-5983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-942-1952
-----------------------------------------------------
Fax | 325-942-1517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, MANAGER
-----------------------------------------------------
Name | DR. RICHARD MCGRAW
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 325-942-1952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------