Provider Demographics
NPI:1548590078
Name:RICHTER, KIMBERLY TERECE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:TERECE
Last Name:RICHTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 SCENIC VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2192
Mailing Address - Country:US
Mailing Address - Phone:281-900-4374
Mailing Address - Fax:
Practice Address - Street 1:12505 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6051
Practice Address - Country:US
Practice Address - Phone:281-993-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65608101YP2500X
39657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208574804Medicaid
TX208574802Medicaid
TX39657OtherPSYCHOLOGIST LICENSE