MEDICARE: MR. TERRY J RICHARDSON MSW

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	1041C0700X	Clinical Social Worker	2002023867	MO

General Provider Information

NPI Number	:	1487657490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY J RICHARDSON MSW

Provider Business Mailing Address
First Line	:	1905 W 32ND ST
Second Line	:	STE 305
City	:	JOPLIN
State	:	MO
Zip	:	64804-1512
Country	:	US
Telephone Number	:	417-626-7966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 W 32ND ST
Second Line	:	STE 305
City	:	JOPLIN
State	:	MO
Zip	:	64804-1512
Country	:	US
Telephone Number	:	417-626-7966
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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