Healthcare Provider Details

I. General information

NPI: 1194837286
Provider Name (Legal Business Name): THE RICHMOND CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 SOUTH HIGH AVENUE
AMES IA
50010-8055
US

IV. Provider business mailing address

1619 SOUTH HIGH AVENUE
AMES IA
50010-8055
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-5811
  • Fax: 515-232-7491
Mailing address:
  • Phone: 515-232-5811
  • Fax: 515-232-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. PAM BARKLEY
Title or Position: CONTROLLER
Credential:
Phone: 515-232-5811