Provider Demographics
NPI:1205174679
Name:PACKARD, RICHARD LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LYNN
Last Name:PACKARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:321 HIGH SCHOOL RD NE
Mailing Address - Street 2:PMB #218
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2647
Mailing Address - Country:US
Mailing Address - Phone:206-321-1017
Mailing Address - Fax:206-641-3426
Practice Address - Street 1:216 1ST AVE S
Practice Address - Street 2:SUITE 333
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3441
Practice Address - Country:US
Practice Address - Phone:206-321-1017
Practice Address - Fax:206-641-3246
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1613103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic