Provider Demographics
NPI:1558479709
Name:THEIS, RICHARD R (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:THEIS
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 1:7940 FLOYD CURL
Mailing Address - Street 2:#1040
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-7564
Mailing Address - Fax:210-615-8950
Practice Address - Street 1:7940 FLOYD CURL
Practice Address - Street 2:#1040
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-7564
Practice Address - Fax:210-615-8950
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25821103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127474804Medicaid
00439EMedicare ID - Type Unspecified