Provider Demographics
NPI:1568608230
Name:RAUBOLT, RICHARD RALEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RALEIGH
Last Name:RAUBOLT
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 1:2735 WOODCLIFF CIR SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3152
Mailing Address - Country:US
Mailing Address - Phone:616-957-0647
Mailing Address - Fax:616-957-9619
Practice Address - Street 1:967 SPAULDING AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3700
Practice Address - Country:US
Practice Address - Phone:616-940-1100
Practice Address - Fax:616-957-9619
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist