Provider Demographics
NPI:1609851062
Name:RICHARDS, GREGG RANKIN (LPCC)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:RANKIN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6861
Mailing Address - Country:US
Mailing Address - Phone:740-396-0093
Mailing Address - Fax:614-291-3800
Practice Address - Street 1:165 W CENTER ST STE 203
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3741
Practice Address - Country:US
Practice Address - Phone:740-223-5624
Practice Address - Fax:740-375-6329
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHE-2050101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11539997OtherCAQH UNIVERSAL CREDENTIAL