Healthcare Provider Details

I. General information

NPI: 1912122219
Provider Name (Legal Business Name): GREG SCOTT RICH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 E 19TH ST
CHEYENNE WY
82001-4646
US

IV. Provider business mailing address

518 E 19TH ST
CHEYENNE WY
82001-4646
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-6146
  • Fax:
Mailing address:
  • Phone: 307-637-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number211
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: