MEDICARE: JODY RICH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	76959	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08070875	OTHER	TX	TEXAS

General Provider Information

NPI Number	:	1841756657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY RICH LPC

Provider Business Mailing Address
First Line	:	4411 SPICEWOOD SPRINGS RD APT 211
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8570
Country	:	US
Telephone Number	:	512-999-0373
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 SPICEWOOD SPRINGS RD APT 211
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8570
Country	:	US
Telephone Number	:	512-999-0373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2019
Last Update Date	:	09/07/2022

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Directions to “ JODY RICH LPC” Practice Location

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