Richard, Marietta Baccus
Richard, Marietta Baccus is an individual health care provider with primary practice located at 1725 E Southlake Blvd Ste 102 , Southlake TX 76092-6457. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Richard, Marietta Baccus can be contacted via phone (682) 477-4400.Contact Information
Primary practice address
1725 E Southlake Blvd Ste 102
Southlake TX 76092-6457
Phone: (682) 477-4400
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 24396 | Texas |
Profile Details
| NPI number | 1699950782 |
|---|---|
| LBN Legal business name | Richard, Marietta Baccus |
| Credentials | PH.D |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 8th, 2008 |
| Last updated | Jun 28th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699950782 | NPPES |
| Texas | Other | 8K4637 | DOCS MCR |
| Texas | Other | 8K4700 | DOCS MCR |
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