Provider Demographics
NPI:1164961413
Name:TODD, RICHARD (MA, LP, CCFC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:TODD
Suffix:
Gender:M
Credentials:MA, LP, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:3833 COON RAPIDS BLVD NW STE 120
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2599
Practice Address - Country:US
Practice Address - Phone:763-767-3350
Practice Address - Fax:763-767-0912
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3225103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling