Provider Demographics
NPI:1114723962
Name:RICHARDSON, JEREMY P (RBT)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:P
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 S 500 W
Mailing Address - Street 2:
Mailing Address - City:MODOC
Mailing Address - State:IN
Mailing Address - Zip Code:47358-9312
Mailing Address - Country:US
Mailing Address - Phone:434-426-0429
Mailing Address - Fax:
Practice Address - Street 1:3601 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5408
Practice Address - Country:US
Practice Address - Phone:765-282-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician