Provider Demographics
NPI:1235266495
Name:SELLARS, RICHARD W (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:SELLARS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BROADWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-7600
Mailing Address - Country:US
Mailing Address - Phone:605-668-3100
Mailing Address - Fax:
Practice Address - Street 1:3515 BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-7600
Practice Address - Country:US
Practice Address - Phone:605-668-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR02613Medicare UPIN
SD3200Medicare ID - Type UnspecifiedMEDICARE #