| Richmond Psychological Services, Llc | |
|
5353 Gamble Dr Ste 395 St Louis Park MN 55416-1510 | |
| (612) 524-8763 | |
| (952) 925-5972 |
| Full Name | Richmond Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 5353 Gamble Dr Ste 395, St Louis Park, Minnesota |
| Authorized Official Name and Position | Adeya Richmond (OWNER) |
| Authorized Official Contact | 6125248763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richmond Psychological Services, Llc 5353 Gamble Dr Ste 395 St Louis Park MN 55416-1510 Ph: (612) 524-8763 | Richmond Psychological Services, Llc 5353 Gamble Dr Ste 395 St Louis Park MN 55416-1510 Ph: (612) 524-8763 |
| NPI Number | 1639671530 |
|---|---|
| Provider Enumeration Date | 03/06/2018 |
| Last Update Date | 03/19/2018 |
| Medicare PECOS PAC ID | 1759643315 |
|---|---|
| Medicare Enrollment ID | O20180319001167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639671530 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 5455 (Minnesota) | Primary |
| Provider Name | Adeya N Richmond |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013295526 PECOS PAC ID: 7517133812 Enrollment ID: I20120109000779 |
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