Provider Demographics
NPI:1902112147
Name:EASLEY, RICHELLE YVETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:YVETTE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15450 FM 1325
Mailing Address - Street 2:APT 2718
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-2808
Mailing Address - Country:US
Mailing Address - Phone:512-925-8667
Mailing Address - Fax:
Practice Address - Street 1:15450 FM 1325
Practice Address - Street 2:APT 2718
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-2808
Practice Address - Country:US
Practice Address - Phone:512-925-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX539221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2084P0800XMedicaid