Individual
SCOTT RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3934 RIO VISTA WAY, KLAMATH FALLS, OR 97603
(662) 687-4969
Mailing address
3934 RIO VISTA WAY, KLAMATH FALLS, OR 97603-7729
(662) 687-4969
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
519169
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519169
—
OR
Enumeration date
12/29/2017
Last updated
12/29/2017
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