Provider Demographics
NPI:1912329939
Name:RICHARDS, ALLEN STAYNER (LCSW (9/2016))
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:STAYNER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LCSW (9/2016)
Other - Prefix:
Other - First Name:MOENKOPI
Other - Middle Name:
Other - Last Name:COUNSELING PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2177 ALLISON ROW
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8306
Mailing Address - Country:US
Mailing Address - Phone:435-773-8909
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 205B
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5773
Practice Address - Country:US
Practice Address - Phone:435-817-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW 2ND YEAR INTERN104100000X
UT9068997-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker