Basic Information
| Provider Information | |||||||||
| NPI: | 1720410236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | KELL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4615 GOVERNMENT ST | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259254282 | ||||||||
| FaxNumber: | 2259251987 | ||||||||
| Practice Location | |||||||||
| Address1: | 12080 MARSTON ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707223217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256838551 | ||||||||
| FaxNumber: | 2256833788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2013 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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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 | 101YA0400X | 1326 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.