Provider Demographics
NPI:1699073528
Name:RICHTER, BRENT (LPC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:RICHTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7218 FORESTVIEW LN N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5644
Mailing Address - Country:US
Mailing Address - Phone:763-274-4028
Mailing Address - Fax:
Practice Address - Street 1:7218 FORESTVIEW LN N
Practice Address - Street 2:SUITE 107
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5644
Practice Address - Country:US
Practice Address - Phone:763-274-4028
Practice Address - Fax:763-322-8854
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00992101YP2500X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst