Provider Demographics
NPI:1235551086
Name:RICHARD O TEMPLE PHD PLLC
Entity Type:Organization
Organization Name:RICHARD O TEMPLE PHD PLLC
Other - Org Name:MIND FOR SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-294-2304
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-0145
Mailing Address - Country:US
Mailing Address - Phone:512-318-1833
Mailing Address - Fax:512-852-4771
Practice Address - Street 1:706B W BEN WHITE BLVD
Practice Address - Street 2:STE 120B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7153
Practice Address - Country:US
Practice Address - Phone:512-318-1833
Practice Address - Fax:512-852-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32760103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366609265OtherRICHARD O TEMPLE'S PERSONAL NPI