Provider Demographics
NPI:1265235964
Name:VANG, RICHY FUECHEE SR (BA)
Entity type:Individual
Prefix:
First Name:RICHY
Middle Name:FUECHEE
Last Name:VANG
Suffix:SR
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11115 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-9600
Mailing Address - Country:US
Mailing Address - Phone:651-399-1796
Mailing Address - Fax:
Practice Address - Street 1:11115 12TH ST N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-9600
Practice Address - Country:US
Practice Address - Phone:651-399-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician