Provider Demographics
NPI:1801621719
Name:FOUCHT, RICHARD RYAN (CB61447799)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RYAN
Last Name:FOUCHT
Suffix:
Gender:M
Credentials:CB61447799
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8342
Mailing Address - Country:US
Mailing Address - Phone:425-270-9578
Mailing Address - Fax:
Practice Address - Street 1:12826 SE 40TH LN
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4278
Practice Address - Country:US
Practice Address - Phone:425-270-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61447799106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician