MEDICARE: DR. PAUL RICHARD CUPPETT PSYD

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	103TC0700X	Clinical Psychologist	32664	TX

General Provider Information

NPI Number	:	1649389883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL RICHARD CUPPETT PSYD

Provider Business Mailing Address
First Line	:	PO BOX 174541
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76003-4541
Country	:	US
Telephone Number	:	817-375-8890
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WESTWAY PL
Second Line	:	SUITE 547
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5245
Country	:	US
Telephone Number	:	817-375-8890
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/11/2014

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