Provider Demographics
NPI:1124884762
Name:RICHARDSON, SHAUN TRAMAINE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:TRAMAINE
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 WAVECREST DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-7926
Mailing Address - Country:US
Mailing Address - Phone:817-723-6704
Mailing Address - Fax:
Practice Address - Street 1:420 HAWKINS RUN RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6654
Practice Address - Country:US
Practice Address - Phone:214-530-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65486101YA0400X
TX92703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)