Richard a Kolotkin PHD PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

RICHARD A KOLOTKIN PHD PA

Practice address

403 Center Ave
Suite 601
Moorhead, MN 56560-1975

Phone

(701) 280-2484

Fax

(701) 232-2220

NPI assigned

Feb 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard A Kolotkin, PHD

Title

President

Phone

(701) 280-2484

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841338548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 CENTER AVE",
            "address_2": "SUITE 601",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565601975",
            "telephone_number": "701-280-2484",
            "fax_number": "701-232-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 CENTER AVE",
            "address_2": "SUITE 601",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565601975",
            "telephone_number": "701-280-2484",
            "fax_number": "701-232-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD A KOLOTKIN PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOLOTKIN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-280-2484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST CLINICAL",
            "identifier": "ND 108",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST CLINICAL",
            "identifier": "MN LP",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jazmina Priscila Reyes Perez
• Caiden Rheault
• Rashawnda Nicole Rice
• Andrea Grace Witte Richards, BCBA
• Emily Richards, LPCC
• Menetta D Richards
• Nathan Richman, LADC
• Michael John Richter

• Clinical Psychologist in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.