Provider Demographics
NPI:1710207337
Name:MANGEN, RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MANGEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 S QUEBEC ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-7601
Mailing Address - Country:US
Mailing Address - Phone:303-875-3297
Mailing Address - Fax:303-721-8770
Practice Address - Street 1:6444 S QUEBEC ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-7601
Practice Address - Country:US
Practice Address - Phone:303-875-3297
Practice Address - Fax:303-721-8770
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical