Provider Demographics
NPI:1871790634
Name:RICHARDSON, BETTY LOU (PHD, RN, CNS-PSYC)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:LOU
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD, RN, CNS-PSYC
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:LOU
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, RN, CNS-PSY
Mailing Address - Street 1:5207 DOE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7103
Mailing Address - Country:US
Mailing Address - Phone:512-346-9264
Mailing Address - Fax:512-346-9264
Practice Address - Street 1:5207 DOE VALLEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7103
Practice Address - Country:US
Practice Address - Phone:512-346-9264
Practice Address - Fax:512-346-9264
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3566106H00000X
TX456053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456053OtherR.N. LICENSE
TX3566OtherLMFT LICENSE