Provider Demographics
NPI:1811165921
Name:STAPLETON, RICHARD A (EDD, LMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:STAPLETON
Suffix:
Gender:M
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 SILVER MAPLE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4738
Mailing Address - Country:US
Mailing Address - Phone:641-233-8959
Mailing Address - Fax:319-351-5432
Practice Address - Street 1:1655 SILVER MAPLE TRL
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4738
Practice Address - Country:US
Practice Address - Phone:641-233-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2080101YP2500X
IA001527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0272021Medicaid