Healthcare Provider Details

I. General information

NPI: 1912190463
Provider Name (Legal Business Name): RICHARD JOHN LINDQUIST LPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 08/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 MASON HOLLOW RD
LIBERTY TN
37095-9201
US

IV. Provider business mailing address

1617 MASON HOLLOW RD
LIBERTY TN
37095-9201
US

V. Phone/Fax

Practice location:
  • Phone: 615-563-4116
  • Fax: 615-563-4116
Mailing address:
  • Phone: 615-563-4116
  • Fax: 615-563-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPE0000011555
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: