Provider Demographics
NPI:1083875116
Name:RICHARDSON, TESS (LAC)
Entity Type:Individual
Prefix:MRS
First Name:TESS
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 N ORACLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7313
Mailing Address - Country:US
Mailing Address - Phone:520-877-7910
Mailing Address - Fax:
Practice Address - Street 1:8339 N ORACLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-7313
Practice Address - Country:US
Practice Address - Phone:520-877-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist