Healthcare Provider Details

I. General information

NPI: 1255051173
Provider Name (Legal Business Name): RICHARD NOVITSKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14435 N 7TH ST STE 101
PHOENIX AZ
85022-4378
US

IV. Provider business mailing address

13213 N 18TH ST
PHOENIX AZ
85022-5039
US

V. Phone/Fax

Practice location:
  • Phone: 480-395-4928
  • Fax:
Mailing address:
  • Phone: 480-395-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24370
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: