Provider Demographics
NPI:1396995452
Name:RICHARDSON, AMY L (MED, LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:RICHARDSON
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 1:234 CONCHO ST
Mailing Address - Street 2:
Mailing Address - City:TYE
Mailing Address - State:TX
Mailing Address - Zip Code:79563-2310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3115 LOOP 306
Practice Address - Street 2:STE. 110
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5983
Practice Address - Country:US
Practice Address - Phone:325-942-1952
Practice Address - Fax:325-942-1517
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional