Healthcare Provider Details

I. General information

NPI: 1841807294
Provider Name (Legal Business Name): COURTNEY ALANE EADDY-RICHARDSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16206 WESTLAKE CIR
VAN BUREN TOWNSHIP MI
48111-6146
US

IV. Provider business mailing address

5961 COTTONWOOD DR
YPSILANTI MI
48197-8203
US

V. Phone/Fax

Practice location:
  • Phone: 734-904-5075
  • Fax:
Mailing address:
  • Phone: 734-904-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number25142150522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: