Healthcare Provider Details

I. General information

NPI: 1124884762
Provider Name (Legal Business Name): SHAUN TRAMAINE RICHARDSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HAWKINS RUN RD STE 100
MIDLOTHIAN TX
76065-6639
US

IV. Provider business mailing address

1506 WAVECREST DR
GLENN HEIGHTS TX
75154-7926
US

V. Phone/Fax

Practice location:
  • Phone: 214-530-2335
  • Fax:
Mailing address:
  • Phone: 817-723-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92703
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number65486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: