Provider Demographics
NPI:1073792909
Name:RICHARDS, TRAMELL
Entity Type:Individual
Prefix:
First Name:TRAMELL
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BARDIN GREENE DR APT 1016
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5288
Mailing Address - Country:US
Mailing Address - Phone:832-524-5658
Mailing Address - Fax:
Practice Address - Street 1:1100 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6630
Practice Address - Country:US
Practice Address - Phone:817-255-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100299-TEMP104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100299OtherLMSW-TEMP