Provider Demographics
NPI:1215210638
Name:RICH, MICHAEL TROY (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TROY
Last Name:RICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 POWELL PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7522
Mailing Address - Country:US
Mailing Address - Phone:765-717-3774
Mailing Address - Fax:
Practice Address - Street 1:8903 SLAYTON ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-0109
Practice Address - Country:US
Practice Address - Phone:765-717-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional