Provider Demographics
NPI:1750768230
Name:RIDDICK, RICHELLE
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 S JONES BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6766
Mailing Address - Country:US
Mailing Address - Phone:702-829-1021
Mailing Address - Fax:725-240-7727
Practice Address - Street 1:3035 S JONES BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6766
Practice Address - Country:US
Practice Address - Phone:702-829-1021
Practice Address - Fax:725-240-7727
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-15-02785106S00000X
NVLBA0796103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician