Provider Demographics
NPI:1952386526
Name:LAFANS, RICHARD S (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:LAFANS
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 1:14300 NICOLLET CT
Mailing Address - Street 2:STE 130
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-3422
Mailing Address - Country:US
Mailing Address - Phone:952-435-8814
Mailing Address - Fax:952-435-7705
Practice Address - Street 1:14300 NICOLLET CT
Practice Address - Street 2:STE 130
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-3422
Practice Address - Country:US
Practice Address - Phone:952-435-8814
Practice Address - Fax:952-435-7705
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
680001841Medicare ID - Type Unspecified