Provider Demographics
NPI:1104974773
Name:YURCHESHEN, RICHARD PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:YURCHESHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 STE 203C
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2159
Practice Address - Country:US
Practice Address - Phone:210-734-6668
Practice Address - Fax:210-734-6660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21782103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JC51OtherBCBS
TX00JC51OtherBCBS