Provider Demographics
NPI:1477060705
Name:RICHEY, BENJAMIN LANE (RBT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LANE
Last Name:RICHEY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TURNBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-1925
Mailing Address - Country:US
Mailing Address - Phone:912-247-7749
Mailing Address - Fax:912-247-7749
Practice Address - Street 1:204 TURNBERRY ST
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-1925
Practice Address - Country:US
Practice Address - Phone:912-247-7749
Practice Address - Fax:912-247-7749
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-17-1870-74439106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician