Provider Demographics
NPI:1902551252
Name:GREG HUPP, PHD, PLLC
Entity Type:Organization
Organization Name:GREG HUPP, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-893-6337
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-0636
Mailing Address - Country:US
Mailing Address - Phone:512-893-6337
Mailing Address - Fax:
Practice Address - Street 1:4413 SPICEWOOD SPRINGS RD STE 308
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8580
Practice Address - Country:US
Practice Address - Phone:512-893-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty