MEDICARE: CRYSTAL RICHARDSON PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MO

General Provider Information

NPI Number	:	1114624236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL RICHARDSON PLPC

Provider Business Mailing Address
First Line	:	7505 NW TIFFANY SPRINGS PKWY
Second Line	:	STE 510
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1389
Country	:	US
Telephone Number	:	816-399-4204
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 NW TIFFANY SPRINGS PKWY
Second Line	:	SUITE 510
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1389
Country	:	US
Telephone Number	:	816-399-4204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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