Healthcare Provider Details

I. General information

NPI: 1215756242
Provider Name (Legal Business Name): RICHIE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 E THUNDERBIRD RD # 18-273
PHOENIX AZ
85032-5838
US

IV. Provider business mailing address

4315 E THUNDERBIRD RD # 18-273
PHOENIX AZ
85032-5838
US

V. Phone/Fax

Practice location:
  • Phone: 623-505-5476
  • Fax:
Mailing address:
  • Phone: 480-444-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN RICHIE
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 623-505-5476