Provider Demographics
NPI:1881624971
Name:PECK, RICHARD L (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:PECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:L
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4111 COUNTRY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5006
Mailing Address - Country:US
Mailing Address - Phone:972-250-4331
Mailing Address - Fax:972-248-0460
Practice Address - Street 1:4111 COUNTRY BROOK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5006
Practice Address - Country:US
Practice Address - Phone:972-250-4331
Practice Address - Fax:972-447-0454
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23637103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent