Provider Demographics
NPI:1194795302
Name:STATES, RICHARD MARK (MA, LPC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:STATES
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2311
Mailing Address - Country:US
Mailing Address - Phone:814-771-7264
Mailing Address - Fax:
Practice Address - Street 1:533 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2311
Practice Address - Country:US
Practice Address - Phone:814-771-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPL002948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001767829OtherHIGHMARK BC/BS