Provider Demographics
NPI:1023305166
Name:RICHARDSON, TRESA HARRIS (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:TRESA
Middle Name:HARRIS
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12496 OLD 79
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MO
Mailing Address - Zip Code:63459-2741
Mailing Address - Country:US
Mailing Address - Phone:573-248-2051
Mailing Address - Fax:573-248-2051
Practice Address - Street 1:12496 OLD 79
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MO
Practice Address - Zip Code:63459-2741
Practice Address - Country:US
Practice Address - Phone:573-248-2051
Practice Address - Fax:573-248-2051
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0010811041C0700X
IL149.0129041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical