Basic Information
| Provider Information | |||||||||
| NPI: | 1164514840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | HUGH THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6640 INTECH BLVD | ||||||||
| Address2: | STE 195 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462782011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172950608 | ||||||||
| FaxNumber: | 3172950622 | ||||||||
| Practice Location | |||||||||
| Address1: | 6640 INTECH BLVD | ||||||||
| Address2: | STE 195 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462782011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172950608 | ||||||||
| FaxNumber: | 3172950622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 99023416A | IN | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 20042189 | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.