Provider Demographics
NPI:1770765968
Name:RICHMOND, AMIE TUCKETT (LCSW)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:TUCKETT
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 E RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5905
Mailing Address - Country:US
Mailing Address - Phone:435-668-2543
Mailing Address - Fax:
Practice Address - Street 1:1173 S 250 W STE 203
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6741
Practice Address - Country:US
Practice Address - Phone:435-574-4966
Practice Address - Fax:435-275-2484
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9434354-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty