Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 754 | LA |
Y | 103T00000X | Psychologist | 754 | LA |
NPI | 1003845843 |
---|---|
Provider Name | Richard L Wakefield |
First Address | Ball, LA 71405-3356 |
Second Address | Ball, LA 71405-3356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/07/2007 |