Provider Demographics
NPI:1922101849
Name:MOODY, RICHARD ALLEN (PSYD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:MOODY
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 1:1500 WSC
Mailing Address - Street 2:COUNSELING AND CAREER CENTER - BYU
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-7906
Mailing Address - Country:US
Mailing Address - Phone:801-422-3035
Mailing Address - Fax:801-422-0173
Practice Address - Street 1:1500 WSC
Practice Address - Street 2:COUNSELING AND CAREER CENTER - BYU
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-7906
Practice Address - Country:US
Practice Address - Phone:801-422-3035
Practice Address - Fax:801-422-0173
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT343067-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical