Provider Demographics
NPI:1104788827
Name:DEWALDEN, RICHARD JERRID (LMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JERRID
Last Name:DEWALDEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 BOXELDER AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6095
Mailing Address - Country:US
Mailing Address - Phone:407-761-3953
Mailing Address - Fax:
Practice Address - Street 1:881 BOXELDER AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-6095
Practice Address - Country:US
Practice Address - Phone:407-761-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health