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General NPI Number Information
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NPI Number | 1841338548
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Entity Type | Organization
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Legal Business Name | RICHARD A KOLOTKIN PHD PA
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 403 CENTER AVE SUITE 601
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City | MOORHEAD
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State | MN
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Zip | 56560-1975
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Country | US
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Telephone | 701-280-2484
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Fax | 701-232-2220
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Provider Business Mailing Address
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Address Line | 403 CENTER AVE SUITE 601
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City | MOORHEAD
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State | MN
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Zip | 56560-1975
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Country | US
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Telephone | 701-280-2484
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Fax | 701-232-2220
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD A KOLOTKIN
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Credential | PHD
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Telephone | 701-280-2484
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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 |
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License Number State |
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