Provider Demographics
NPI:1003238726
Name:WADDLETON, RIOS
Entity Type:Individual
Prefix:MR
First Name:RIOS
Middle Name:
Last Name:WADDLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 W GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3944
Mailing Address - Country:US
Mailing Address - Phone:432-528-8595
Mailing Address - Fax:
Practice Address - Street 1:2404 W GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3944
Practice Address - Country:US
Practice Address - Phone:432-528-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68616101YM0800X
TX68016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health