Healthcare Provider Details

I. General information

NPI: 1215210638
Provider Name (Legal Business Name): MICHAEL TROY RICH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 SLAYTON ST
PENDLETON IN
46064-0109
US

IV. Provider business mailing address

205 POWELL PL
BRENTWOOD TN
37027-7522
US

V. Phone/Fax

Practice location:
  • Phone: 765-717-3774
  • Fax:
Mailing address:
  • Phone: 765-717-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: