Healthcare Provider Details

I. General information

NPI: 1346308293
Provider Name (Legal Business Name): SHELLEY ANN RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

530 SANTA CLARA AVE #207
ALAMEDA CA
94501-3274
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax: 650-367-6465
Mailing address:
  • Phone: 650-367-1890
  • Fax: 650-367-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: