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General NPI Number Information
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NPI Number | 1174509558
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Entity Type | Individual
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Provider Name | LONDON SCOTT RICHARD PHD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 939 MISSILE RD 382 TRS/CC, SUITE 2
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-2397
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Fax | 940-676-3633
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Provider Business Mailing Address
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Address Line | 3 TWELVE OAKS CT
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1467
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Country | US
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Telephone | 940-696-8853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 14028
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License Number State | CA
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