MEDICARE: DR. ENID RICHEY PH.D.

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	103TC0700X	Clinical Psychologist	2900	OR
2	103T00000X	Psychologist	2900	OR

General Provider Information

NPI Number	:	1447279922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENID RICHEY PH.D.

Provider Business Mailing Address
First Line	:	2440 WILLAMETTE ST STE 201
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-3170
Country	:	US
Telephone Number	:	541-321-2278
Fax Number	:	541-246-8826

Provider Business Practice Location Address
First Line	:	2440 WILLAMETTE ST STE 201
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-3170
Country	:	US
Telephone Number	:	541-321-2278
Fax Number	:	541-246-8826

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/07/2023

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