Provider Demographics
NPI:1861969701
Name:RICHEY, BRIAN J (ATP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:RICHEY
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N GLENVILLE DR STE 501
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1957
Mailing Address - Country:US
Mailing Address - Phone:972-480-0990
Mailing Address - Fax:
Practice Address - Street 1:210 ENTERPRISE ST STE C
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-5071
Practice Address - Country:US
Practice Address - Phone:972-480-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89467225CA2500X, 247200000X, 225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other