Provider Demographics
NPI:1629766373
Name:RICHARD, NGABHO
Entity Type:Individual
Prefix:
First Name:NGABHO
Middle Name:
Last Name:RICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 W BRANHAM LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2724
Mailing Address - Country:US
Mailing Address - Phone:480-600-8395
Mailing Address - Fax:
Practice Address - Street 1:6618 W BRANHAM LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2724
Practice Address - Country:US
Practice Address - Phone:480-600-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH8370106S00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician