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General NPI Number Information
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NPI Number | 1447872726
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Entity Type | Individual
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Provider Name | MICHAEL RICHARDS
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Gender | Male
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Dates
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Enumeration Date | 05/10/2020
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 3091 SIR HAMILTON CIR
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City | TITUSVILLE
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State | FL
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Zip | 32780-4959
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Country | US
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Telephone | 321-593-0926
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 GIBSON BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5566
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Country | US
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Telephone | 407-690-9412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | NMLPCC0190521
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License Number State | NM
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