Provider Demographics
NPI:1245314681
Name:MUNSON, RICHARD JEFFREY (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:MUNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:104 B WEST OLD ANDREW JOHNSON HIGHWAY
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-0287
Mailing Address - Country:US
Mailing Address - Phone:865-471-1460
Mailing Address - Fax:865-471-1460
Practice Address - Street 1:104 B WEST OLD AJ HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-0287
Practice Address - Country:US
Practice Address - Phone:865-471-1460
Practice Address - Fax:865-471-1460
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP00001896103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3686443Medicare PIN