Provider Demographics
NPI:1457711509
Name:WELLINGTON, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WELLINGTON
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 1:1891 JIM KEENE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-8000
Mailing Address - Country:US
Mailing Address - Phone:863-298-6200
Mailing Address - Fax:
Practice Address - Street 1:1891 JIM KEENE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-8000
Practice Address - Country:US
Practice Address - Phone:863-298-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2025-01-22
Deactivation Date:2023-12-20
Deactivation Code:
Reactivation Date:2025-01-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist