Basic Information
| Provider Information | |||||||||
| NPI: | 1104311893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | CARLEY | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11820 CYPRESS CORNER LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770651132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818941423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17302 HOUSE HAHL RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774338213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3464457575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1913 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.