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General NPI Number Information
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NPI Number | 1164514840
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Entity Type | Individual
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Provider Name | JONATHAN HUGH THOMAS RICHARDSON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 11/03/2024
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Provider Practice Location Address
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Address Line | 6640 INTECH BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-2011
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Country | US
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Telephone | 317-274-8812
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Fax | 317-274-0133
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Provider Business Mailing Address
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Address Line | PO BOX 778912
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City | CHICAGO
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State | IL
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Zip | 60677-8912
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Country | US
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Telephone | 317-777-6435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042189
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 99023416A
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License Number State | IN
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