Corey L Richardson, LCSW
Social Worker, Clinical in American Falls, ID. Individual provider (NPI-1).
NPI number1285962779
StatusActive
Last updated in NPPESJan 11, 2021
Details
- NPI
- 1285962779
- Entity type
- Individual (NPI-1)
- Name
- Corey L Richardson
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 23, 2009
- Certification date
- Jan 11, 2021
- Last updated
- Jan 11, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | Idaho LCSW-28906 | ID | Yes |
Practice location
745 Reed StAmerican Falls, ID 83211-1334
Phone 208-244-8771
Mailing address
745 Reed StAmerican Falls, ID 83211-1334
Phone 208-244-8771
Other practice locations
151 N 3rd Ave Ste 330
Pocatello, ID 83201-6369
Pocatello, ID 83201-6369
Phone 208-244-8771
5230 W Moonlight Mine Rd
Pocatello, ID 83201-9013
Pocatello, ID 83201-9013
Phone 208-244-8771
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