Provider Demographics
NPI:1154157543
Name:NTI, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:NTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 KILLEBREW DR # 211
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1865
Mailing Address - Country:US
Mailing Address - Phone:952-212-0358
Mailing Address - Fax:
Practice Address - Street 1:1701 AMERICAN BLVD E # 19
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1151
Practice Address - Country:US
Practice Address - Phone:952-212-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health