Provider Demographics
NPI:1801814421
Name:RICHARDSON, MARY K (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 MAIN ST
Mailing Address - Street 2:STE. 401
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2646
Mailing Address - Country:US
Mailing Address - Phone:816-753-7071
Mailing Address - Fax:816-753-8189
Practice Address - Street 1:4901 MAIN ST
Practice Address - Street 2:STE. 401
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2646
Practice Address - Country:US
Practice Address - Phone:816-753-7071
Practice Address - Fax:816-753-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY 01363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
280217OtherVALUE OPTIONS
MO15126012OtherBC/BS KC
69352OtherCIGNA
KS567219OtherBC/BS KS
280217OtherVALUE OPTIONS
KS567219OtherBC/BS KS