Provider Demographics
NPI:1417413204
Name:MANN, RICHARD (PSYD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N HEATHERWILDE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4195
Mailing Address - Country:US
Mailing Address - Phone:512-704-8349
Mailing Address - Fax:512-693-4006
Practice Address - Street 1:305 N HEATHERWILDE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4195
Practice Address - Country:US
Practice Address - Phone:512-704-8349
Practice Address - Fax:512-693-4006
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical