Provider Demographics
NPI:1235120692
Name:FLOURNOY, RICHARD L (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:FLOURNOY
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:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1332
Mailing Address - Country:US
Mailing Address - Phone:903-572-1406
Mailing Address - Fax:903-572-1446
Practice Address - Street 1:104 S VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-4438
Practice Address - Country:US
Practice Address - Phone:903-572-1406
Practice Address - Fax:903-572-1446
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
117602OtherINTEGRATED MH SVC/SUP HTH
24251OtherCIGNA
TX00DC30OtherBCBS OF TX
5086164OtherAETNA
188704OtherVALUE OPTIONS
188704OtherVALUE OPTIONS
TX00DC30OtherBCBS OF TX