Provider Demographics
NPI:1639232556
Name:JAMES THOMAS RICHARDSON
Entity Type:Organization
Organization Name:JAMES THOMAS RICHARDSON
Other - Org Name:PSYCHOLOGICAL RESOURCES GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LP
Authorized Official - Phone:612-481-1600
Mailing Address - Street 1:8490 WOODBURY XING
Mailing Address - Street 2:STE 107
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9433
Mailing Address - Country:US
Mailing Address - Phone:612-481-1600
Mailing Address - Fax:651-731-6345
Practice Address - Street 1:8490 WOODBURY XING
Practice Address - Street 2:STE 107
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9433
Practice Address - Country:US
Practice Address - Phone:612-481-1600
Practice Address - Fax:651-731-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2150103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN242227100Medicaid
MN62-36220OtherUBH