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NPI Code Detail

MEDICARE: RICHARDSON PSYCHOLOGICAL SERVICES PLLC

MEDICARE: RICHARDSON PSYCHOLOGICAL SERVICES PLLC
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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1154075539
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARDSON PSYCHOLOGICAL SERVICES PLLC
Provider Business Mailing Address
First Line : 7207 BLUEBILL ST
Second Line :
City : CLAY
State : MI
Zip : 48001-4105
Country : US
Telephone Number : 810-488-1202
Fax Number :
Provider Business Practice Location Address
First Line : 632 N MILL ST
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-1422
Country : US
Telephone Number : 734-404-8646
Fax Number :
Authorized Official
Title or Position : FOUNDER AND CLINICAL DIRECTOR
Name : PATRICIA RICHARDSON
Credential : PHD
Telephone Number : 734-404-8646
Provider Enumeration Date : 02/04/2022
Last Update Date : 02/04/2022

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