Provider Demographics
NPI:1902407273
Name:NORTH, RICHARD EARL III
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EARL
Last Name:NORTH
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 W BASELINE RD
Mailing Address - Street 2:SUITE 182 #533
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041
Mailing Address - Country:US
Mailing Address - Phone:602-675-0514
Mailing Address - Fax:
Practice Address - Street 1:9430 S 34TH LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2506
Practice Address - Country:US
Practice Address - Phone:602-675-0514
Practice Address - Fax:855-572-6173
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst