Healthcare Provider Details

I. General information

NPI: 1295966646
Provider Name (Legal Business Name): KELLEE NICHOLE RICHARDS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 WOODFOREST BLVD SUITE 110
HOUSTON TX
77015-3564
US

IV. Provider business mailing address

12360 RICHMOND AVE APARTMENT #1737
HOUSTON TX
77082-2421
US

V. Phone/Fax

Practice location:
  • Phone: 713-453-2300
  • Fax:
Mailing address:
  • Phone: 832-428-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: