Basic Information
| Provider Information | |||||||||
| NPI: | 1811933039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHMOND | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179624836 | ||||||||
| FaxNumber: | 3179628646 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 KESSLER BOULEVARD EAST DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462202890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174756200 | ||||||||
| FaxNumber: | 3174756212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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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 | 104100000X | 39000741 | IN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.