Basic Information
| Provider Information | |||||||||
| NPI: | 1649466673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHEY | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | KENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 832 E PIONEER AVE | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923741802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097983304 | ||||||||
| FaxNumber: | 9516868565 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 CHICAGO AVE STE 180 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925073418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516868500 | ||||||||
| FaxNumber: | 9516868565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.