Provider Demographics
NPI:1821696659
Name:RICHMOND, GLORIA (LMFT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9713
Mailing Address - Country:US
Mailing Address - Phone:530-328-0780
Mailing Address - Fax:
Practice Address - Street 1:5149 FRONT ST
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9713
Practice Address - Country:US
Practice Address - Phone:530-329-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YM0800X
CA148610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health