Provider Demographics
NPI:1285148668
Name:RICHARDS, DORY (LMFT)
Entity type:Individual
Prefix:
First Name:DORY
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15207
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0114
Mailing Address - Country:US
Mailing Address - Phone:352-606-0323
Mailing Address - Fax:
Practice Address - Street 1:7281 SUNSHINE GROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6800
Practice Address - Country:US
Practice Address - Phone:352-606-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist