Provider Demographics
NPI:1265712780
Name:RICHARDSON, AMBER WHEELER (PHD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:WHEELER
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 1:1906B GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2430
Mailing Address - Country:US
Mailing Address - Phone:573-778-0705
Mailing Address - Fax:573-778-0925
Practice Address - Street 1:225 PHYSICIANS PARK
Practice Address - Street 2:STE 300
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3930
Practice Address - Country:US
Practice Address - Phone:573-778-0705
Practice Address - Fax:573-778-0925
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011028483103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical