Healthcare Provider Details

I. General information

NPI: 1871179721
Provider Name (Legal Business Name): RYEN A RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CORDOVA ST STE 101
ANCHORAGE AK
99503-2745
US

IV. Provider business mailing address

2521 E MOUNTAIN VILLAGE DR SUITE B PMB 797
WASILLA AK
99654
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-9640
  • Fax:
Mailing address:
  • Phone: 907-521-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: