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General NPI Number Information
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NPI Number | 1720451032
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Entity Type | Organization
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Legal Business Name | DR. W. WAYNE RICKARD
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 102 HAZEL PATH STE 5
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3889
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Country | US
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Telephone | 615-543-4667
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Fax |
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Provider Business Mailing Address
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Address Line | 102 HAZEL PATH STE 5
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3889
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Country | US
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Telephone | 615-543-4667
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | DR. WALTER WAYNE RICKARD
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Credential | LMFT
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Telephone | 615-543-4667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMT0000001161
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License Number State | TN
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