Provider Demographics
NPI:1790151298
Name:ELGERSMA, RICHARD (M LITT, LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:ELGERSMA
Suffix:
Gender:M
Credentials:M LITT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 106TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3736
Mailing Address - Country:US
Mailing Address - Phone:515-635-1805
Mailing Address - Fax:
Practice Address - Street 1:2540 106TH ST STE 202
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3736
Practice Address - Country:US
Practice Address - Phone:515-635-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084789106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist