=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548549173
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANAVIA NAOMI RICHARDSON MBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2011
-----------------------------------------------------
Last Update Date | 08/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5202 CEDAR ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-775-5203
-----------------------------------------------------
Fax | 713-431-4524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9701 FORUM PARK DR STE 920
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-775-5203
-----------------------------------------------------
Fax | 713-431-5245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 13315
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------