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General NPI Number Information
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NPI Number | 1538781679
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Entity Type | Individual
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Provider Name | DAVID R RICHIE PH,D
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Gender | Male
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 680 RUSSELL RD
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City | BOLIVAR
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State | TN
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Zip | 38008-3573
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Country | US
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Telephone | 731-658-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 680 RUSSELL RD
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City | BOLIVAR
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State | TN
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Zip | 38008-3573
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Country | US
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Telephone | 731-658-7150
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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 | P0000001233
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License Number State | TN
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