Provider Demographics
NPI:1912190463
Name:LINDQUIST, RICHARD JOHN (LPE)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOHN
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 MASON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TN
Mailing Address - Zip Code:37095-9201
Mailing Address - Country:US
Mailing Address - Phone:615-563-4116
Mailing Address - Fax:615-563-4116
Practice Address - Street 1:1617 MASON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TN
Practice Address - Zip Code:37095-9201
Practice Address - Country:US
Practice Address - Phone:615-563-4116
Practice Address - Fax:615-563-4116
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical