Provider Demographics
NPI:1063560654
Name:R. P. YURCHESHEN, PH.D., P.C.
Entity type:Organization
Organization Name:R. P. YURCHESHEN, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:YURCHESHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-734-6668
Mailing Address - Street 1:6391 DE ZAVALA RD STE 203C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2159
Mailing Address - Country:US
Mailing Address - Phone:210-734-6668
Mailing Address - Fax:210-734-6660
Practice Address - Street 1:6391 DE ZAVALA RD
Practice Address - Street 2:STE 203C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2143
Practice Address - Country:US
Practice Address - Phone:210-734-6668
Practice Address - Fax:210-734-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21782103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JC51OtherBCBS
TX0341463-01Medicaid
TX27739900OtherTRICARE
TX0341463-01Medicaid