Healthcare Provider Details

I. General information

NPI: 1215683230
Provider Name (Legal Business Name): TAYLOR J RICHARDS SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 AURORA AVE N
SEATTLE WA
98133-7511
US

IV. Provider business mailing address

2320 E MADISON ST STE A6
SEATTLE WA
98112-5569
US

V. Phone/Fax

Practice location:
  • Phone: 253-999-5750
  • Fax:
Mailing address:
  • Phone: 206-741-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.61547473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: