MEDICARE: RICHARD H PRATT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY0168	NV

General Provider Information

NPI Number	:	1528141462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD H PRATT PH.D.

Provider Business Mailing Address
First Line	:	284 E LAKE MEAD PKWY STE C
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-6433
Country	:	US
Telephone Number	:	702-251-0044
Fax Number	:	702-566-3301

Provider Business Practice Location Address
First Line	:	701 N GREEN VALLEY PKWY STE 293
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6177
Country	:	US
Telephone Number	:	702-251-0044
Fax Number	:	702-566-3301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	04/13/2009

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