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NPI Code Detail

MEDICARE: KELLY GARRISON RICHTER LCSW

MEDICARE: KELLY GARRISON RICHTER LCSW
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 Worker7407LA

General Provider Information

NPI Number : 1487858643
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY GARRISON RICHTER LCSW
Provider Business Mailing Address
First Line : 11994 OLD HAMMOND HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-8649
Country : US
Telephone Number : 225-773-0750
Fax Number :
Provider Business Practice Location Address
First Line : 4550 NORTH BLVD STE 250
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-4013
Country : US
Telephone Number : 225-927-1269
Fax Number : 225-927-7367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2007
Last Update Date : 07/08/2007

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