Provider Demographics
NPI:1538780804
Name:STOTTS, RICHARD HAMILTON
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:HAMILTON
Last Name:STOTTS
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 1:10015 CALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2341
Mailing Address - Country:US
Mailing Address - Phone:210-445-7998
Mailing Address - Fax:
Practice Address - Street 1:10015 CALLEY CIR
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2341
Practice Address - Country:US
Practice Address - Phone:210-445-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health