Healthcare Provider Details

I. General information

NPI: 1952363590
Provider Name (Legal Business Name): RICHARD WALLACE HARIG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E CHARLIES TRL RAYMOND W BLISS ARMY HEALTH CENTER
HUACHUCA CITY AZ
85616-8173
US

IV. Provider business mailing address

1855 E CHARLIES TRL RAYMOND W BLISS ARMY HEALTH CENTER
HUACHUCA CITY AZ
85616-8173
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-9250
  • Fax:
Mailing address:
  • Phone: 520-533-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12639
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0514
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: