Provider Demographics
NPI:1174509558
Name:RICHARD, LONDON SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LONDON
Middle Name:SCOTT
Last Name:RICHARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TWELVE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1467
Mailing Address - Country:US
Mailing Address - Phone:940-696-8853
Mailing Address - Fax:
Practice Address - Street 1:939 MISSILE RD
Practice Address - Street 2:382 TRS/CC, SUITE 2
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-2397
Practice Address - Fax:940-676-3633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical