Provider Demographics
NPI:1780994319
Name:SANOK, RICHARD LOUIS (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:SANOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNION ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3290
Mailing Address - Country:US
Mailing Address - Phone:231-929-2600
Mailing Address - Fax:231-929-7760
Practice Address - Street 1:500 S UNION ST
Practice Address - Street 2:SUITE 4
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3290
Practice Address - Country:US
Practice Address - Phone:231-929-2600
Practice Address - Fax:231-929-7760
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-17
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist