Provider Demographics
NPI:1124405436
Name:GRIEBE, RICHARD JR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GRIEBE
Suffix:JR
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 1:106 E 2ND AVE.
Mailing Address - Street 2:BOX 31
Mailing Address - City:YODER
Mailing Address - State:WY
Mailing Address - Zip Code:82244-0031
Mailing Address - Country:US
Mailing Address - Phone:307-401-1004
Mailing Address - Fax:
Practice Address - Street 1:1765 W C ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3215
Practice Address - Country:US
Practice Address - Phone:307-401-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician