Individual
RICHARD PUCKETT
Active
Individual
RICHARD PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPMED
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1835
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223G6PU
BLUE CROSS BLUE SHIELD MN
MN
01
—
6254190
MEDICA
MN
Enumeration date
09/16/2006
Last updated
07/09/2007
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