Provider Demographics
NPI:1447279922
Name:RICHEY, ENID (PHD)
Entity type:Individual
Prefix:DR
First Name:ENID
Middle Name:
Last Name:RICHEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 WILLAMETTE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3170
Mailing Address - Country:US
Mailing Address - Phone:541-321-2278
Mailing Address - Fax:541-246-8826
Practice Address - Street 1:2440 WILLAMETTE ST STE 201
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3170
Practice Address - Country:US
Practice Address - Phone:541-321-2278
Practice Address - Fax:541-246-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2900103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL146200Medicare ID - Type Unspecified