Provider Demographics
NPI:1366515355
Name:WARREN, PAUL LAWRENCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LAWRENCE
Last Name:WARREN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 WESTCREEK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2256
Mailing Address - Country:US
Mailing Address - Phone:817-292-4179
Mailing Address - Fax:817-292-2544
Practice Address - Street 1:5658 WESTCREEK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-2256
Practice Address - Country:US
Practice Address - Phone:817-292-4179
Practice Address - Fax:817-292-2544
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U23XMedicare ID - Type UnspecifiedMEDICARE NUMBER