Provider Demographics
NPI:1033126966
Name:RICHESON, ELIZABETH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:L
Last Name:RICHESON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STAR RIDGE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-833-2311
Mailing Address - Fax:
Practice Address - Street 1:600 SUNLAND PARK DR
Practice Address - Street 2:BLDG. 6 STE. 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5115
Practice Address - Country:US
Practice Address - Phone:915-584-3636
Practice Address - Fax:915-587-0487
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical