Provider Demographics
NPI:1447476015
Name:BLAK, RICHARD ARTHUR (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:BLAK
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 1:358 E HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0886
Mailing Address - Country:US
Mailing Address - Phone:559-434-6942
Mailing Address - Fax:
Practice Address - Street 1:7341 N 1ST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2948
Practice Address - Country:US
Practice Address - Phone:559-431-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7172103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic