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NPI 1407912504

NPI 1407912504 : MR. RICHARD W. FUGITT : ROCKWALL, TX

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General NPI Number Information
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    NPI Number           |    1407912504
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    Entity Type          |    Individual 
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    Provider Name        |    MR. RICHARD W. FUGITT
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    12/31/2006
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    Last Update Date     |    07/09/2007
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Provider Practice Location Address
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    Address Line         |    562 W RALPH M HALL PKWY 
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    City                 |    ROCKWALL
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    State                |    TX
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    Zip                  |    75032-6644
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    Country              |    US
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    Telephone            |    972-948-6359
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    Fax                  |    972-722-8009
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Provider Business Mailing Address
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    Address Line         |    PO BOX 2186 
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    City                 |    ROCKWALL
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    State                |    TX
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    Zip                  |    75087-5086
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    Country              |    US
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    Telephone            |    972-948-6359
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    Fax                  |    972-722-8009
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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        |    101YM0800X
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    Taxonomy Name        |    Mental Health Counselor
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    License Number       |    40059
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    License Number State |    TX
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