Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 6301007813 | MI |
N | 103TF0000X | Family Psychologist | 6301007813 | MI |
N | 103TH0004X | Health Psychologist | 6301007813 | MI |
N | 103TP2701X | Group Psychotherapist | 6301007813 | MI |
Y | 103TR0400X | Rehabilitation Psychologist | 6301007813 | MI |
NPI | 1295070027 |
---|---|
Provider Name | Dr. Richard Alan Tackett |
First Address | Coldwater, MI 49036-0174 |
Second Address | Coldwater, MI 49036-1142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2012 |
Last Update Date | 05/12/2012 |