Provider Demographics
NPI:1215114095
Name:JANKA, RICHARD THOMAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:JANKA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4622
Mailing Address - Country:US
Mailing Address - Phone:734-927-1201
Mailing Address - Fax:734-927-1203
Practice Address - Street 1:409 PLYMOUTH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1497
Practice Address - Country:US
Practice Address - Phone:734-927-1201
Practice Address - Fax:734-927-1203
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013595103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling