Provider Demographics
NPI:1699296855
Name:ECHOLS, RICHARD LAWRENCE
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:ECHOLS
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 1:25701 RAVINE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2256
Mailing Address - Country:US
Mailing Address - Phone:248-353-4729
Mailing Address - Fax:248-353-4746
Practice Address - Street 1:25701 RAVINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2256
Practice Address - Country:US
Practice Address - Phone:248-353-4729
Practice Address - Fax:248-353-4746
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF630280241320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities