Provider Demographics
NPI:1932923570
Name:MONFORT, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MONFORT
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 1:2335 S 225 E
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-8771
Mailing Address - Country:US
Mailing Address - Phone:765-584-1024
Mailing Address - Fax:
Practice Address - Street 1:2335 S 225 E
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-8771
Practice Address - Country:US
Practice Address - Phone:765-584-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health