Healthcare Provider Details

I. General information

NPI: 1548284748
Provider Name (Legal Business Name): RICHARD H. HUNTER PH.D., ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10202 BRIGGS RD
MARION IL
62959-5844
US

IV. Provider business mailing address

10202 BRIGGS RD
MARION IL
62959-5844
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-1044
  • Fax:
Mailing address:
  • Phone: 618-997-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number071-003169
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071-003169
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-003169
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number071-003169
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number071-003169
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: