Individual
PAUL K CHAFETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
8340 MEADOW RD STE 134, #134, DALLAS, TX 75231
(469) 233-5566
Mailing address
PO BOX 92878, SOUTHLAKE, TX 76092
(817) 470-6676
(541) 637-0298
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
22365
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00SD78
BLUE CROSS BLUE SHIELD
TX
05
—
035835001
—
TX
01
—
620001485
MEDICARE RAILROAD
TX
Enumeration date
08/08/2006
Last updated
05/24/2018
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