MEDICARE: LARELL 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1609290410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARELL RICHARDSON

Provider Business Mailing Address
First Line	:	650 E AZURE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6885
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 E AZURE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6885
Country	:	US
Telephone Number	:	702-337-6572
Fax Number	:

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

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/13/2014

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Directions to “ LARELL RICHARDSON ” Practice Location

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