Provider Demographics
NPI:1083736540
Name:GRENHART, RICHARD FRANKLIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANKLIN
Last Name:GRENHART
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-0366
Mailing Address - Country:US
Mailing Address - Phone:303-332-6948
Mailing Address - Fax:
Practice Address - Street 1:145 PARK ST # 366
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9902
Practice Address - Country:US
Practice Address - Phone:720-251-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CO952103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07024656Medicaid
CO07024656Medicaid
CO9266-6Medicare ID - Type Unspecified