Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 9590 | TX |
NPI | 1013042597 |
---|---|
Provider Name | Helen Jean Richardson |
First Address | Texas City, TX 77591-2628 |
Second Address | Angleton, TX 77515-4480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8528BH | BLUE CROSS BLUE SHIELD (01) | TX |