Provider Demographics
NPI:1508872730
Name:RICHARDS, MEREDITH KELLY (MFT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:KELLY
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9157 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1471
Mailing Address - Country:US
Mailing Address - Phone:916-215-8041
Mailing Address - Fax:
Practice Address - Street 1:9157 LAKEMONT DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1471
Practice Address - Country:US
Practice Address - Phone:916-215-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA274829Medicare UPIN
CA7859659Medicare UPIN