Provider Demographics
NPI:1417598822
Name:RICHIE, ANELA GAIL (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANELA
Middle Name:GAIL
Last Name:RICHIE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31566 RAILROAD CANYON RD STE 2 BOX 1003
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9446
Mailing Address - Country:US
Mailing Address - Phone:760-654-5046
Mailing Address - Fax:
Practice Address - Street 1:22046 SAN JOAQUIN DR W
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7844
Practice Address - Country:US
Practice Address - Phone:951-488-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist