Provider Demographics
NPI:1528384641
Name:MUMFORD, RICHARD LEE JR (MPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:MUMFORD
Suffix:JR
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3621 N KELLEY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-4520
Mailing Address - Country:US
Mailing Address - Phone:405-524-5525
Mailing Address - Fax:405-524-5528
Practice Address - Street 1:3621 N KELLEY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-4520
Practice Address - Country:US
Practice Address - Phone:405-524-5525
Practice Address - Fax:405-524-5528
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1578690137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)