MEDICARE: DR. RICHARD PAUL YURCHESHEN PH.D.

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	21782	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00JC51	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1104974773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PAUL YURCHESHEN PH.D.

Provider Business Mailing Address
First Line	:	6391 DE ZAVALA RD STE 203C
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2159
Country	:	US
Telephone Number	:	210-734-6668
Fax Number	:	210-734-6660

Provider Business Practice Location Address
First Line	:	6391 DE ZAVALA RD STE 203C
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2159
Country	:	US
Telephone Number	:	210-734-6668
Fax Number	:	210-734-6660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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