Provider Demographics
NPI:1902248396
Name:RICHARD M OSTROM, PSY.D. LLC
Entity Type:Organization
Organization Name:RICHARD M OSTROM, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-783-0990
Mailing Address - Street 1:8390 W GAGE BLVD
Mailing Address - Street 2:SUITE # 213
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8105
Mailing Address - Country:US
Mailing Address - Phone:509-783-0990
Mailing Address - Fax:
Practice Address - Street 1:8390 W GAGE BLVD
Practice Address - Street 2:SUITE # 213
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8105
Practice Address - Country:US
Practice Address - Phone:509-783-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty