Provider Demographics
NPI:1326341660
Name:RASH, RICHARD TRAVIS (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TRAVIS
Last Name:RASH
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 DE MUN AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3162
Mailing Address - Country:US
Mailing Address - Phone:314-724-1486
Mailing Address - Fax:314-724-1486
Practice Address - Street 1:929 DE MUN AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3162
Practice Address - Country:US
Practice Address - Phone:314-724-1486
Practice Address - Fax:314-724-1486
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008032510101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional