Provider Demographics
NPI:1457409765
Name:BEBOUT, RICHARD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:BEBOUT
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 1:12621 KAVANAUGH LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2816
Mailing Address - Country:US
Mailing Address - Phone:240-353-5806
Mailing Address - Fax:
Practice Address - Street 1:12621 KAVANAUGH LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2816
Practice Address - Country:US
Practice Address - Phone:240-353-5806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02444103TC0700X
DCPSY1000100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical