Provider Demographics
NPI:1780050476
Name:RICHARDS, KAYSHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAYSHA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 N 83RD AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5650
Mailing Address - Country:US
Mailing Address - Phone:623-335-4504
Mailing Address - Fax:855-811-0596
Practice Address - Street 1:14050 N 83RD AVE STE 290
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5650
Practice Address - Country:US
Practice Address - Phone:623-335-4504
Practice Address - Fax:855-811-0596
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical