Provider Demographics
NPI:1821067752
Name:LUSCOMB, RICHARD LEWIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEWIS
Last Name:LUSCOMB
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 1:7516 ENTERPRISE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3802
Mailing Address - Country:US
Mailing Address - Phone:901-755-5802
Mailing Address - Fax:901-757-2249
Practice Address - Street 1:7516 ENTERPRISE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3802
Practice Address - Country:US
Practice Address - Phone:901-755-5802
Practice Address - Fax:901-757-2249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP870103T00000X
MS24314103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3685570Medicare UPIN
3685570Medicare ID - Type Unspecified