Provider Demographics
NPI:1407983620
Name:SLAUGHTER, RICHARD A III (PSYD PC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SLAUGHTER
Suffix:III
Gender:M
Credentials:PSYD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W ARBROOK BLVD
Mailing Address - Street 2:STE 330
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4327
Mailing Address - Country:US
Mailing Address - Phone:817-417-8782
Mailing Address - Fax:817-417-8766
Practice Address - Street 1:7356 LOVE CIR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-4327
Practice Address - Country:US
Practice Address - Phone:817-417-8782
Practice Address - Fax:817-417-8766
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22893OtherSTATE LICENSE
TX87027AOtherBCBS OF TX PROVIDER#