Provider Demographics
NPI:1518223676
Name:DEBOEST, RICHARD (LMHC, LCAC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DEBOEST
Suffix:
Gender:M
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-1431
Mailing Address - Country:US
Mailing Address - Phone:574-267-3426
Mailing Address - Fax:
Practice Address - Street 1:27 PEQUIGNOT DR
Practice Address - Street 2:
Practice Address - City:PIERCETON
Practice Address - State:IN
Practice Address - Zip Code:46562-9081
Practice Address - Country:US
Practice Address - Phone:574-594-9200
Practice Address - Fax:574-594-9031
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001573A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health