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NPI Code Detail

MEDICARE: SAMUEL LEE RICHARDSON M.S.

MEDICARE: SAMUEL LEE RICHARDSON M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMI0082NV

General Provider Information

NPI Number : 1164719084
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL LEE RICHARDSON M.S.
Provider Business Mailing Address
First Line : 3320 N BUFFALO DR STE 207
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7411
Country : US
Telephone Number : 702-600-6335
Fax Number :
Provider Business Practice Location Address
First Line : 3320 N BUFFALO DR STE 207
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7411
Country : US
Telephone Number : 702-659-4825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2011
Last Update Date : 02/10/2023

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