MEDICARE: STACY LYNN RICHARDS

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	103TS0200X	School Psychologist	T5Y109700331	WV

General Provider Information

NPI Number	:	1972343838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY LYNN RICHARDS

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	SPENCER
State	:	WV
Zip	:	25276-0068
Country	:	US
Telephone Number	:	304-951-0767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 RAIDER WAY
Second Line	:
City	:	SPENCER
State	:	WV
Zip	:	25276-9236
Country	:	US
Telephone Number	:	304-927-6405
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/29/2024

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Directions to “ STACY LYNN RICHARDS ” Practice Location

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