Provider Demographics
NPI:1750650313
Name:RICHMAN, NATHAN (LADC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 11TH ST N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2083
Mailing Address - Country:US
Mailing Address - Phone:218-233-6398
Mailing Address - Fax:218-236-6765
Practice Address - Street 1:715 11TH ST N
Practice Address - Street 2:SUITE 204
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2083
Practice Address - Country:US
Practice Address - Phone:218-233-6398
Practice Address - Fax:218-236-6765
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302904101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)