MEDICARE: RICHARD NOVITSKE

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	24370	AZ

General Provider Information

NPI Number	:	1255051173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD NOVITSKE

Provider Business Mailing Address
First Line	:	13213 N 18TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5039
Country	:	US
Telephone Number	:	480-395-4928
Fax Number	:

Provider Business Practice Location Address
First Line	:	14435 N 7TH ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-4378
Country	:	US
Telephone Number	:	480-395-4928
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	12/16/2025

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