Provider Demographics
NPI:1104437680
Name:RICHARDSON, TEAIRRA L
Entity type:Individual
Prefix:MRS
First Name:TEAIRRA
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20722 BRADFORD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3678
Mailing Address - Country:US
Mailing Address - Phone:816-447-1694
Mailing Address - Fax:
Practice Address - Street 1:4141 SOUTHWEST FWY STE 515
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7364
Practice Address - Country:US
Practice Address - Phone:816-447-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAMedicaid