Provider Demographics
NPI:1225523525
Name:RICHARDS, KYLE FORREST (LMHC, LPC-MH)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:FORREST
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LMHC, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 GLENN ELLEN RD
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8078
Mailing Address - Country:US
Mailing Address - Phone:712-540-4090
Mailing Address - Fax:
Practice Address - Street 1:200 LINDEN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IA
Practice Address - Zip Code:51062-7727
Practice Address - Country:US
Practice Address - Phone:712-540-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092334101Y00000X, 101YM0800X
SDLPC-MH30835101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC-MH30835OtherSD LICENSE NUMBER
IA092334OtherIA LICENSE NUMBER