Healthcare Provider Details

I. General information

NPI: 1992660815
Provider Name (Legal Business Name): COURTNEY HANNAH RICHARDSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 N METRO PKWY E
PHOENIX AZ
85051-1513
US

IV. Provider business mailing address

4849 E ROOSEVELT ST APT 1093
PHOENIX AZ
85008-7342
US

V. Phone/Fax

Practice location:
  • Phone: 480-877-9284
  • Fax:
Mailing address:
  • Phone: 480-276-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23513
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: