Healthcare Provider Details

I. General information

NPI: 1275051583
Provider Name (Legal Business Name): BRIAN RICHTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N OUTER 40 RD # 2B
TOWN AND COUNTRY MO
63017-5941
US

IV. Provider business mailing address

1 CHILDRENS PL STE 3N14
SAINT LOUIS MO
63110-1081
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6069
  • Fax: 314-726-6069
Mailing address:
  • Phone: 314-454-6069
  • Fax: 314-454-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2018042709
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: