Provider Demographics
NPI:1063038610
Name:RICH, MICAH LEIGH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:LEIGH
Last Name:RICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 EL PORTAL DR APT 12
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3154
Mailing Address - Country:US
Mailing Address - Phone:530-736-5445
Mailing Address - Fax:
Practice Address - Street 1:3648 EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3133
Practice Address - Country:US
Practice Address - Phone:530-722-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)