Provider Demographics
NPI:1336967827
Name:GAIRRETT, RICHELLE (MED, LPC)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:GAIRRETT
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-4849
Mailing Address - Country:US
Mailing Address - Phone:660-353-9209
Mailing Address - Fax:
Practice Address - Street 1:132 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-4849
Practice Address - Country:US
Practice Address - Phone:660-353-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional