Individual
DAVID MICHAEL RICHIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
23029 S FORK, SAN ANTONIO, TX 78255-2105
(210) 614-5563
(210) 616-0785
Mailing address
PO BOX 690121, SAN ANTONIO, TX 78269-0121
(210) 614-5563
(210) 616-0785
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
22993
TX
103T00000X
Psychologist
22993
TX
103TH0004X
Health Psychologist
22993
TX
103TR0400X
Rehabilitation Psychologist
22993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00GK60
MEDICARE PTAN
TX
Enumeration date
01/24/2007
Last updated
11/24/2015
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