MEDICARE: PAUL L WARREN, PSYD, PC

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	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114487329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL L WARREN, PSYD, PC

Provider Business Mailing Address
First Line	:	PO BOX 331584
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76163-1584
Country	:	US
Telephone Number	:	817-292-4179
Fax Number	:	817-918-4839

Provider Business Practice Location Address
First Line	:	5658 WESTCREEK DR STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2254
Country	:	US
Telephone Number	:	817-292-4179
Fax Number	:	817-918-4839

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. PAUL LAWRENCE WARREN
Credential	:	PSYD
Telephone Number	:	817-292-4179

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	03/22/2019

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