Clyde A Richardson, M DIV CAC-R

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

6802067415 Issued in MI

Practice address

3210 Eagle Run Dr
Suite 200
Grand Rapids, MI 49525

Phone

(616) 957-1200

Fax

(616) 957-1297

NPI assigned

May 5, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245974400000",
    "number": "1275709826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 EAGLE RUN DR",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-957-1200",
            "fax_number": "616-957-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 EAGLE RUN DR",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-957-1200",
            "fax_number": "616-957-1297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "CLYDE",
        "middle_name": "A",
        "credential": "M DIV CAC-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-05",
        "last_updated": "2009-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6802067415",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6802067415",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "MI",
            "license": "6802067415",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelli Richards, RN
• Lauren Richards, D.C.
• Roxanne L Richards, MD
• Brandon Richardson, PT
• Cameron Richardson, D.O.
• Jonea Monique Richardson
• Karyssa Richardson, MD
• Lesli Ann Richardson, M ED., MA, LLPC
• Margaret Emma Richardson, MA, BCBA, LBA
• Marjeanne Richardson

• Addiction (Substance Use Disorder) Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.