Provider Demographics
NPI:1336639673
Name:EGBERT, RICHARD R
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:EGBERT
Suffix:
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 1:977 LAKEVIEW PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1429
Mailing Address - Country:US
Mailing Address - Phone:224-541-0189
Mailing Address - Fax:847-549-8006
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:224-541-0189
Practice Address - Fax:847-549-8006
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health