Provider Demographics
NPI:1255856704
Name:COLLETTE RICHARDS LPC LLC
Entity Type:Organization
Organization Name:COLLETTE RICHARDS LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-288-8883
Mailing Address - Street 1:4150 W PEORIA AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3954
Mailing Address - Country:US
Mailing Address - Phone:602-288-8883
Mailing Address - Fax:
Practice Address - Street 1:4150 W PEORIA AVE STE 133
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3954
Practice Address - Country:US
Practice Address - Phone:602-288-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-06
Last Update Date:2017-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
AZLPC-16260251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health