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Individual

MICHAEL KEITH RICHARDSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
12271 HARTFORD AVE, OROFINO, ID 83544-9348
(208) 471-8079
(877) 775-0174
Mailing address
PO BOX 381, OROFINO, ID 83544-0381
(208) 471-8079
(877) 775-0174

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-41596
ID
101YM0800X
Mental Health Counselor

Other

Enumeration date
06/23/2015
Last updated
06/06/2022
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