MEDICARE: ELDERPSYCH CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103T00000X	Psychologist	3-1593	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0087QA	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083732838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDERPSYCH CARE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 938
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76540-0938
Country	:	US
Telephone Number	:	254-634-6999
Fax Number	:	254-200-4099

Provider Business Practice Location Address
First Line	:	1007 W. HIGHWAY 190
Second Line	:	STE B
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-3886
Country	:	US
Telephone Number	:	254-542-7200
Fax Number	:	866-602-0977

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY S HUPP
Credential	:	PHD
Telephone Number	:	254-542-7200

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	12/15/2010

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Directions to “ELDERPSYCH CARE PLLC ” Practice Location

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