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General NPI Number Information
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NPI Number | 1972343838
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Entity Type | Individual
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Provider Name | STACY LYNN RICHARDS
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1 RAIDER WAY
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City | SPENCER
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State | WV
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Zip | 25276-9236
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Country | US
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Telephone | 304-927-6405
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | SPENCER
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State | WV
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Zip | 25276-0068
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Country | US
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Telephone | 304-951-0767
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | T5Y109700331
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License Number State | WV
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