Provider Demographics
NPI:1154494417
Name:MALLARD, RICHARD A (MS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:MALLARD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152878
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8878
Mailing Address - Country:US
Mailing Address - Phone:469-628-4368
Mailing Address - Fax:817-784-1917
Practice Address - Street 1:2906 FRANCISCAN DR
Practice Address - Street 2:APT.1715
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2575
Practice Address - Country:US
Practice Address - Phone:469-628-4368
Practice Address - Fax:817-784-1917
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7407101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional