Provider Demographics
NPI:1407231236
Name:RICHARD, JONATHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:RICHARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 S BELLAIRE ST
Mailing Address - Street 2:SUITE 417
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4306
Mailing Address - Country:US
Mailing Address - Phone:303-475-7987
Mailing Address - Fax:
Practice Address - Street 1:1777 S BELLAIRE ST
Practice Address - Street 2:SUITE 417
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4306
Practice Address - Country:US
Practice Address - Phone:303-475-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical