Provider Demographics
NPI:1467507186
Name:RICHARDSON, AMY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5362 STONEBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1702
Mailing Address - Country:US
Mailing Address - Phone:580-513-2479
Mailing Address - Fax:
Practice Address - Street 1:622 BRYAN DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3462
Practice Address - Country:US
Practice Address - Phone:580-920-0909
Practice Address - Fax:580-931-3119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional