MEDICARE: MS. COURTNEY ALANE EADDY-RICHARDSON PSYD

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	103T00000X	Psychologist	25142150522	MI

General Provider Information

NPI Number	:	1841807294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COURTNEY ALANE EADDY-RICHARDSON PSYD

Provider Business Mailing Address
First Line	:	5961 COTTONWOOD DR
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-8203
Country	:	US
Telephone Number	:	734-904-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	16206 WESTLAKE CIR
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-6146
Country	:	US
Telephone Number	:	734-904-5075
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	07/29/2025

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