Provider Demographics
NPI:1821144817
Name:POLLOCK, RICHARD LARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LARRY
Last Name:POLLOCK
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 1:7707 FANNIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1926
Mailing Address - Country:US
Mailing Address - Phone:713-797-6773
Mailing Address - Fax:713-797-6210
Practice Address - Street 1:7707 FANNIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1926
Practice Address - Country:US
Practice Address - Phone:713-797-6773
Practice Address - Fax:713-797-6210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21149103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CH23Medicare ID - Type Unspecified
TXR57243Medicare UPIN