Provider Demographics
NPI:1821356866
Name:FOGARTY, RICHARD THOMAS
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THOMAS
Last Name:FOGARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 QUAIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1919
Mailing Address - Country:US
Mailing Address - Phone:405-201-0276
Mailing Address - Fax:
Practice Address - Street 1:3209 QUAIL CREEK RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1919
Practice Address - Country:US
Practice Address - Phone:405-201-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor