Healthcare Provider Details

I. General information

NPI: 1932046752
Provider Name (Legal Business Name): BRANDON J RICHARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E FARREL RD STE B
LAFAYETTE LA
70508-7183
US

IV. Provider business mailing address

332 E FARREL RD STE B
LAFAYETTE LA
70508-7183
US

V. Phone/Fax

Practice location:
  • Phone: 337-517-3742
  • Fax:
Mailing address:
  • Phone: 337-517-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1299
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: