Healthcare Provider Details

I. General information

NPI: 1760313423
Provider Name (Legal Business Name): ALYSSA LYNN RICHARDSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7353 E SUGARLOAF ST
MESA AZ
85207-0948
US

IV. Provider business mailing address

11441 E BROADWAY RD
MESA AZ
85208-7929
US

V. Phone/Fax

Practice location:
  • Phone: 480-652-3250
  • Fax:
Mailing address:
  • Phone: 661-201-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-25-469802
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: