Individual
RICHARD PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPMED
Contact information
Practice address
2618 EMERALD DR, GRAND RAPIDS, MN 55744-5060
(218) 327-9013
(218) 327-9013
Mailing address
2618 EMERALD DR, GRAND RAPIDS, MN 55744-5060
(218) 327-9013
(218) 327-9013
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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