Provider Demographics
NPI:1558495051
Name:KNEIP, RICHARD CARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARL
Last Name:KNEIP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210550
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48321-0550
Mailing Address - Country:US
Mailing Address - Phone:248-701-2017
Mailing Address - Fax:248-605-3525
Practice Address - Street 1:6548 TOWN CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4823
Practice Address - Country:US
Practice Address - Phone:248-701-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007060103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N89500Medicare UPIN