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NPI Code Detail

MEDICARE: TRINA RICHARDSON

MEDICARE: TRINA RICHARDSON
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1649559865
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRINA RICHARDSON
Provider Business Mailing Address
First Line : PO BOX 60100
Second Line :
City : BOULDER CITY
State : NV
Zip : 89006-0100
Country : US
Telephone Number : 702-294-7100
Fax Number :
Provider Business Practice Location Address
First Line : 100 SAINT JUDES ST
Second Line :
City : BOULDER CITY
State : NV
Zip : 89005-1614
Country : US
Telephone Number : 702-294-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/04/2011

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Directions to “ TRINA RICHARDSON ” Practice Location

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