Provider Demographics
NPI:1013309756
Name:RICHMOND, RYAN ALLEN
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ALLEN
Last Name:RICHMOND
Suffix:
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 1:1970 STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5525
Mailing Address - Country:US
Mailing Address - Phone:605-350-0279
Mailing Address - Fax:
Practice Address - Street 1:1970 STEPHENS RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5525
Practice Address - Country:US
Practice Address - Phone:605-350-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst