Provider Demographics
NPI:1467180471
Name:RICHARDSON, KEVIN B
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2212
Mailing Address - Country:US
Mailing Address - Phone:405-334-6913
Mailing Address - Fax:
Practice Address - Street 1:421 E THOMAS AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2600
Practice Address - Country:US
Practice Address - Phone:405-372-7791
Practice Address - Fax:405-372-7776
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health