Basic Information
| Provider Information | |||||||||
| NPI: | 1811308679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | COLLETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062611 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1110 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026851940 | ||||||||
| FaxNumber: | 6026851944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2014 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 14486 | AZ | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.