Provider Demographics
NPI:1407912504
Name:FUGITT, RICHARD W
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:FUGITT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:W
Other - Last Name:FUGITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2186
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5086
Mailing Address - Country:US
Mailing Address - Phone:972-948-6359
Mailing Address - Fax:972-722-8009
Practice Address - Street 1:562 W RALPH M HALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6644
Practice Address - Country:US
Practice Address - Phone:972-948-6359
Practice Address - Fax:972-722-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40059OtherSTATE LCSW #