Basic Information
| Provider Information | |||||||||
| NPI: | 1497809651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUNYAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | DUANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 MOUNTAIN ST STE 3H | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457756 | ||||||||
| FaxNumber: | 7758410304 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 MOUNTAIN ST STE 3H | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457756 | ||||||||
| FaxNumber: | 7758410304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103TC0700X | PY0386 | NV | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.