Basic Information
| Provider Information | |||||||||
| NPI: | 1952523870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | RUBY | ||||||||
| MiddleName: | NELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2610 INDUSTRY WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105379780 | ||||||||
| FaxNumber: | 3105379753 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 INDUSTRY WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105379780 | ||||||||
| FaxNumber: | 3105379753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC42557 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.