Provider Demographics
NPI:1649446469
Name:TIMOTHY J RICHTER PH.D. PC
Entity type:Organization
Organization Name:TIMOTHY J RICHTER PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-245-8112
Mailing Address - Street 1:1018 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0732
Mailing Address - Country:US
Mailing Address - Phone:406-245-8112
Mailing Address - Fax:406-245-7074
Practice Address - Street 1:1018 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0732
Practice Address - Country:US
Practice Address - Phone:406-245-8112
Practice Address - Fax:406-245-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT562 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0254254Medicaid