1659599306 NPI number — RICK L. ANTHONY

Table of content: MOLLY FERGUSON LPC LMFT (NPI 1285659854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659599306 NPI number — RICK L. ANTHONY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICK L. ANTHONY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659599306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 W AVENUE A
Provider Second Line Business Mailing Address:
STE# 100
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76504-4080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-778-6474
Provider Business Mailing Address Fax Number:
254-778-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 W AVENUE A
Provider Second Line Business Practice Location Address:
STE# 100
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76504-4080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-778-6474
Provider Business Practice Location Address Fax Number:
254-778-6491
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANTHONY
Authorized Official First Name:
RICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER & MANAGER
Authorized Official Telephone Number:
254-778-6474

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0078NZ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com