Provider Demographics
NPI:1679661599
Name:STAUFFACHER, RICHARD A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:STAUFFACHER
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 1:3012 SUNRISE AVE
Mailing Address - Street 2:P.O. BOX 106
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4047
Mailing Address - Country:US
Mailing Address - Phone:575-443-3268
Mailing Address - Fax:
Practice Address - Street 1:1211 HAWAII AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6437
Practice Address - Country:US
Practice Address - Phone:575-443-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical