Healthcare Provider Details

I. General information

NPI: 1467507186
Provider Name (Legal Business Name): AMY RICHARDSON L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BRYAN DR
DURANT OK
74701-3462
US

IV. Provider business mailing address

5362 STONEBRIAR CIR
DURANT OK
74701-1702
US

V. Phone/Fax

Practice location:
  • Phone: 580-920-0909
  • Fax: 580-931-3119
Mailing address:
  • Phone: 580-513-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2190
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: