Provider Demographics
NPI:1255564084
Name:RICHTER, JAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:RICHTER
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 1:1147 COUNTY ROAD 389
Mailing Address - Street 2:
Mailing Address - City:WETMORE
Mailing Address - State:CO
Mailing Address - Zip Code:81253-9505
Mailing Address - Country:US
Mailing Address - Phone:719-784-3430
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY 3200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical