Healthcare Provider Details

I. General information

NPI: 1548845647
Provider Name (Legal Business Name): ERIC BRENT RICHARDSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7791 HIGHLAND MEADOWS PKWY STE C
WINDSOR CO
80528-8991
US

IV. Provider business mailing address

PO BOX 802
WELLINGTON CO
80549-0802
US

V. Phone/Fax

Practice location:
  • Phone: 970-971-8661
  • Fax: 970-971-8661
Mailing address:
  • Phone: 801-824-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number733
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: