Provider Demographics
NPI:1366659526
Name:RICH, KATHLEEN DIANE (PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:DIANE
Last Name:RICH
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:GLENEDEN BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97388-0244
Mailing Address - Country:US
Mailing Address - Phone:541-764-2635
Mailing Address - Fax:
Practice Address - Street 1:7755 HWY 101
Practice Address - Street 2:MARKET PLACE AT SALISHAN SUITE 1A1
Practice Address - City:GLENEDEN BEACH
Practice Address - State:OR
Practice Address - Zip Code:97388-0244
Practice Address - Country:US
Practice Address - Phone:541-764-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR737103T00000X
OR11081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical