Provider Demographics
NPI:1912171828
Name:FRED LEE RICHARDSON
Entity Type:Organization
Organization Name:FRED LEE RICHARDSON
Other - Org Name:KERRVILLE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,LCDC,LM&FT
Authorized Official - Phone:830-792-3900
Mailing Address - Street 1:P.O. BOX 134
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-1013
Mailing Address - Country:US
Mailing Address - Phone:830-792-3900
Mailing Address - Fax:
Practice Address - Street 1:625 CLAY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4586
Practice Address - Country:US
Practice Address - Phone:830-792-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty