Provider Demographics
NPI:1700379112
Name:RICHERT, RICHARD A (LMHC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:RICHERT
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 VINEYARD CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6321
Mailing Address - Country:US
Mailing Address - Phone:277-203-4987
Mailing Address - Fax:
Practice Address - Street 1:1589 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4653
Practice Address - Country:US
Practice Address - Phone:727-203-4987
Practice Address - Fax:727-205-4492
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health