Michael David Richardson, ED.D, LCPC, CRADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

001395 Issued in MO

Practice address

12496 Old 79
New London, MO 63459-2741

Phone

(573) 248-2051

Fax

(573) 248-2051

NPI assigned

Oct 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walters Walk

  • Professional Counselor
  • Hazelwood, MO
  • NPI 1609442441

  MO, Professional

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1154510196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12496 OLD 79",
            "city": "NEW LONDON",
            "state": "MO",
            "postal_code": "634592741",
            "telephone_number": "573-248-2051",
            "fax_number": "573-248-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12496 OLD 79",
            "city": "NEW LONDON",
            "state": "MO",
            "postal_code": "634592741",
            "telephone_number": "573-248-2051",
            "fax_number": "573-248-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "ED.D, LCPC, CRADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-16",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "001395",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.002197",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "498873918",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Comprehensive Health Systems, Inc.
• Comprehensive Health Systems, Inc.
• Independent Mobility LLC
• Preferred Family Healthcare, Inc
• Ralls County Health Department
• Tresa Harris Richardson, MSW, LCSW, ACSW
• Amber Roberts, MS PLPC/CRADC
• Kim Robinson, LPC

• All providers in New London, MO
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.