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General NPI Number Information
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NPI Number | 1760872568
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Entity Type | Organization
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Legal Business Name | RICHLAND PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 9037 E D AVE
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City | RICHLAND
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State | MI
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Zip | 49083-9454
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Country | US
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Telephone | 269-629-2207
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Fax | 269-731-2881
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Provider Business Mailing Address
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Address Line | 9037 E D AVE PO BOX 253
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City | RICHLAND
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State | MI
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Zip | 49083-9454
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Country | US
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Telephone | 269-629-2207
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Fax | 269-731-2881
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/MEMBER OWNER
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Name | DR. LISA KIMBERLY LARGO-MARSH
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Credential | PH.D.
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Telephone | 269-629-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301008181
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License Number State | MI
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