Marietta Baccus Richard in Southlake - Clinical
Marietta Baccus Richard - NPI 1699950782
Marietta Baccus Richard is a Clinical in Southlake, Texas. Marietta Baccus Richard practices all healthcare services and medical treatments related to Clinical. The NPI Number for Marietta Baccus Richard is 1699950782. The last update date is 2019-06-28.
Marietta Baccus Richard's current location address is 1725 E Southlake Blvd Ste 102, Southlake, Texas. You can contact this provider via phone number 6824774400. The mailing address for Marietta Baccus Richard is 1725 E Southlake Blvd Ste 102, Southlake, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Marietta Baccus Richard |
|---|---|
| Address | 1725 E Southlake Blvd Ste 102, Southlake, Texas |
| Phone Number | 6824774400 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | PH.D |
NPI Number Detail
| NPI Number | 1699950782 |
|---|---|
| Provider Enumeration Date | 2008-01-08 |
| Last Updated Date | 2019-06-28 |
Provider Mailing Address Detail
| Address | 1725 E Southlake Blvd Ste 102 |
|---|---|
| City | Southlake |
| State | Texas (TX) |
| Post Code | 760926457 |
| Phone Number | 6824774400 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 24396 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 8K4637 | TX | DOCS MCR | |
| 8K4700 | TX | DOMHA MCR |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Marietta Baccus Richard by the Centers for Medicare & Medicaid Services?
The Marietta Baccus Richard has been issued the NPI (National Provider Identifier) 1699950782, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete address where Marietta Baccus Richard is physically located?
The Marietta Baccus Richard is situated at the following address: 1725 E Southlake Blvd Ste 102, Southlake, TX 760926457.
What is Marietta Baccus Richard's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Marietta Baccus Richard is Clinical, and the taxonomy classification code that categorizes this area of expertise is 103Tc0700X.
On what date did Marietta Baccus Richard receive its 1699950782 assignment from the Centers for Medicare & Medicaid Services?
The Marietta Baccus Richard was assigned its 1699950782 on 2008-01-08, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details related to Marietta Baccus Richard most recently updated or revised?
The information pertaining to Marietta Baccus Richard, including its address, specialty, and other relevant details, was last updated or revised on 2019-06-28.