Provider Demographics
NPI:1588739643
Name:STUDER, RICHARD JULIAN (MA, LMFT, LP, LICSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JULIAN
Last Name:STUDER
Suffix:
Gender:M
Credentials:MA, LMFT, LP, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 W LAKE ST
Mailing Address - Street 2:SUITE 2000S
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2554
Mailing Address - Country:US
Mailing Address - Phone:612-381-2494
Mailing Address - Fax:612-381-2494
Practice Address - Street 1:1919 UNIVERSITY AVE W
Practice Address - Street 2:G6
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3453
Practice Address - Country:US
Practice Address - Phone:651-641-1555
Practice Address - Fax:651-641-0340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1132103TC0700X
MNLICSW 65241041C0700X
MNLMFT 109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4D024STOtherBCBS PIN
MN160765OtherUCARE PROVIDER NUMBER
MNHP38838OtherHEALTH PARTNERS
MN02498STOtherBCBS GROUP NUMBER