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NPI Code Detail

MEDICARE: EVAN RICHARDSON

MEDICARE: EVAN RICHARDSON
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
11041C0700XClinical Social WorkerIC-2881NV
2101YA0400XAddiction (Substance Use Disorder) Counselor
3104100000XSocial Worker12797-MNV
4101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1336991983
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN RICHARDSON
Provider Business Mailing Address
First Line : 714 E SAHARA AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-2942
Country : US
Telephone Number : 702-369-8700
Fax Number :
Provider Business Practice Location Address
First Line : 714 E SAHARA AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-2942
Country : US
Telephone Number : 702-369-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2024
Last Update Date : 02/20/2026

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Directions to “ EVAN RICHARDSON ” Practice Location

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