Provider Demographics
NPI:1053363895
Name:MOREY, RICHARD EUGENE (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:MOREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-0714
Mailing Address - Country:US
Mailing Address - Phone:805-703-0429
Mailing Address - Fax:805-466-2322
Practice Address - Street 1:8575 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3924
Practice Address - Country:US
Practice Address - Phone:805-703-0429
Practice Address - Fax:805-466-2322
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12822103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL 128220Medicare ID - Type Unspecified