Provider Demographics
NPI:1083395248
Name:RICH, JESSICA (LCPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 S SUMMERTREE LN
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2574
Mailing Address - Country:US
Mailing Address - Phone:757-635-5171
Mailing Address - Fax:
Practice Address - Street 1:15320 S RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2704
Practice Address - Country:US
Practice Address - Phone:913-780-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional