Basic Information
| Provider Information | |||||||||
| NPI: | 1760021638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOWMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 KYLE ST | ||||||||
| Address2: | |||||||||
| City: | WADSWORTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442811418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304076806 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 WADSWORTH RD | ||||||||
| Address2: | |||||||||
| City: | WADSWORTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442819580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2342178882 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2019 | ||||||||
| LastUpdateDate: | 12/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/24/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDCA.172019 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.