Provider Demographics
NPI:1639671530
Name:RICHMOND PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:RICHMOND PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-524-8763
Mailing Address - Street 1:5353 GAMBLE DR STE 395
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1510
Mailing Address - Country:US
Mailing Address - Phone:612-524-8763
Mailing Address - Fax:952-925-5972
Practice Address - Street 1:5353 GAMBLE DR STE 395
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1510
Practice Address - Country:US
Practice Address - Phone:612-524-8763
Practice Address - Fax:952-925-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty