Provider Demographics
NPI:1093371676
Name:RICHARDSON, TODD JUSTIN (PHD, MSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JUSTIN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 CHOUTEAU AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-3052
Mailing Address - Country:US
Mailing Address - Phone:314-798-1856
Mailing Address - Fax:
Practice Address - Street 1:1808 CHOUTEAU AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-3052
Practice Address - Country:US
Practice Address - Phone:314-798-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190119611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical