Provider Demographics
NPI:1225377203
Name:RICHARDSON, BRENDA KAYE
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KAYE
Last Name:RICHARDSON
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 1:6969 PASTOR BAILEY DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2636
Mailing Address - Country:US
Mailing Address - Phone:214-751-3932
Mailing Address - Fax:
Practice Address - Street 1:6969 PASTOR BAILEY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2636
Practice Address - Country:US
Practice Address - Phone:214-751-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional