Provider Demographics
NPI:1538529482
Name:RICHARDS, JOSI MARA MOREIRA (01950-I)
Entity type:Individual
Prefix:MRS
First Name:JOSI MARA
Middle Name:MOREIRA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:01950-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 WILLOW TREE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3355
Mailing Address - Country:US
Mailing Address - Phone:702-280-3759
Mailing Address - Fax:
Practice Address - Street 1:1016 WILLOW TREE DR UNIT A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3355
Practice Address - Country:US
Practice Address - Phone:702-280-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01950-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)