Provider Demographics
NPI:1801058508
Name:SUDSBERRY, RICHARD L
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:SUDSBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 BEECHWOOD CENTRE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7891
Mailing Address - Country:US
Mailing Address - Phone:317-272-8138
Mailing Address - Fax:317-272-8165
Practice Address - Street 1:7519 BEECHWOOD CENTRE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7891
Practice Address - Country:US
Practice Address - Phone:317-272-8138
Practice Address - Fax:317-272-8165
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000746A101YM0800X
IN35000500A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health