DR. MARIETTA BACCUS RICHARD (NPI# 1699950782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699950782 |
| Entity Type | Individual |
| Full Name | DR. MARIETTA BACCUS RICHARD |
| Other Name | MARIETTA BACCUS |
| Credential | PH.D |
| Practice Address |
1725 E Southlake Blvd Ste 102 Southlake TX 76092-6457 |
| Practice Telephone | 6824774400 |
| Mailing Telephone | 6824774400 |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2019-06-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
24396 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | DOCS MCR | 8K4637 | 01 |
| TX | DOMHA MCR | 8K4700 | 01 |
| Street Address |
1725 E SOUTHLAKE BLVD STE 102 |
| City | SOUTHLAKE |
| State | TX |
| Zip Code | 76092-6457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942771787 | Premier Psychology Consultants Pllc | Psychologist | 1725 E Southlake Blvd Ste 102, Southlake, TX 76092-6457 | 2018-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730718990 | Elizabeth Beazley | Family Medicine | 1050 E. Hwy 114 Suite 100, Southlake, TX 76092 | 2020-04-08 |
| 1518508894 | Arbor Pediatrics, Pllc | Pediatrics | 1130 N Kimball Ave, Southlake, TX 76092 | 2019-10-08 |
| 1346882685 | Gs Ortho Assists, Pllc | Physician Assistant | 2600 East Southlake Boulevard Suite 120, Southlake, TX 76092 | 2019-10-08 |
| 1609340496 | Rebecca Leigh Lander | Physician Assistant | 1170 N Carroll Ave., Southlake, TX 76092 | 2019-01-15 |
| 1225506223 | Physicians Wellness Associates Pllc | Family Medicine | 1920 East State Highway 114, Southlake, TX 76092 | 2018-11-07 |
| 1740762459 | Brandi L. Barker | Chiropractor | 590 N. Kimball Ave, Suite 140, Southlake, TX 76092 | 2018-08-30 |
| 1033699228 | Julie A. Seeber | Physical Therapy Assistant | 170 Stonebridge Lane, Southlake, TX 76092 | 2018-08-16 |
| 1992281364 | Alayna Powers | Nurse Practitioner | 900 E Southlake Blvd Ste 300, Southlake, TX 76092 | 2018-07-18 |
| 1346732153 | Amrittej Singh Virk | Dentist | 630 N Kimball Ave Ste 110, Southlake, TX 76092 | 2018-06-06 |
| 1740779594 | Radiant Family Dental Pllc | Dentist | 2012 Southlake Glen Dr., Southlake, TX 76092 | 2018-05-08 |
| Find all providers in zip 76092 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518409374 | Linda Hoover | Psychologist | 185 S. Kimball Ave, Suite 100, Southlake, TX 76092 | 2016-11-10 |
| 1467892810 | Ar Psychological Services Pllc | Psychologist | 231 E Southlake Blvd, Suite 140, Southlake, TX 76092-6285 | 2013-06-30 |
| 1023313939 | Ashley Harrison Noble | Psychologist | 211 E Southlake Blvd Ste 101, Southlake, TX 76092-6274 | 2011-01-24 |
| 1467696823 | Amanpreet Randazzo | Psychologist | 1009 Berkshire Rd, Southlake, TX 76092-4911 | 2009-04-28 |
| 1689754541 | Robert E Holmes | Psychologist | 2485 E Southlake Blvd Ste 180, Southlake, TX 76092-6687 | 2006-10-16 |
| 1235229766 | April Minatrea | Psychologist | 211 E Southlake Blvd, Suite 115, Southlake, TX 76092-6265 | 2006-10-13 |
| 1336156975 | Mark S Rider | Psychologist | 558 Silicon Dr, #102, Southlake, TX 76092-7529 | 2006-08-02 |
| 1114966074 | H. E. B. Behavioral Medicine, P. C. | Psychologist | 305 Miron Dr, Southlake, TX 76092-7831 | 2006-06-06 |
| 1174956700 | Robert N Freedenfeld, Phd, PC | Psychologist | 1207 S White Chapel Blvd, Suite 140, Southlake, TX 76092-9314 | 2013-08-19 |
| 1043563877 | Pf Dover Counseling | Psychologist | 515 W Southlake Blvd, Suite Number 172, Southlake, TX 76092-6172 | 2012-10-17 |
| Find all providers in SOUTHLAKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.