MEDICARE: DR. RICHARD WALLACE HARIG 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	PSY12639	CA
2	103TC0700X	Clinical Psychologist	PY0514	NV

General Provider Information

NPI Number	:	1952363590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WALLACE HARIG PH.D.

Provider Business Mailing Address
First Line	:	1855 E CHARLIES TRL
Second Line	:	RAYMOND W BLISS ARMY HEALTH CENTER
City	:	HUACHUCA CITY
State	:	AZ
Zip	:	85616-8173
Country	:	US
Telephone Number	:	520-533-9250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 E CHARLIES TRL
Second Line	:	RAYMOND W BLISS ARMY HEALTH CENTER
City	:	HUACHUCA CITY
State	:	AZ
Zip	:	85616-8173
Country	:	US
Telephone Number	:	520-533-9250
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	11/14/2012

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