Provider Demographics
NPI:1922359421
Name:DYER, RICHARD R (LLBSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:R
Last Name:DYER
Suffix:
Gender:M
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LANE ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1310
Mailing Address - Country:US
Mailing Address - Phone:517-789-1217
Mailing Address - Fax:
Practice Address - Street 1:1200 N WEST AVE STE 800
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2185
Practice Address - Country:US
Practice Address - Phone:517-789-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker