Provider Demographics
NPI:1295360246
Name:KIMBERLY RICHARDS COUNSELING, LLC
Entity Type:Organization
Organization Name:KIMBERLY RICHARDS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-419-9949
Mailing Address - Street 1:2600 NE FORUM DR APT 44
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5306
Mailing Address - Country:US
Mailing Address - Phone:541-419-9949
Mailing Address - Fax:
Practice Address - Street 1:29 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2911
Practice Address - Country:US
Practice Address - Phone:541-419-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)