Provider Demographics
NPI:1669626636
Name:RICHARDS, IRENE MARGARET (MED)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:MARGARET
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 MOUNT BAKER LOOP
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:AZ
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-416-7546
Mailing Address - Fax:
Practice Address - Street 1:320 PACIFIC PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:AZ
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-416-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60041037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health