Provider Demographics
NPI:1609010149
Name:RICH, KEVIN MARK
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARK
Last Name:RICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W 22ND ST
Mailing Address - Street 2:116A
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5046
Mailing Address - Country:US
Mailing Address - Phone:605-333-6890
Mailing Address - Fax:605-333-6804
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:116A
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117-5046
Practice Address - Country:US
Practice Address - Phone:605-333-6890
Practice Address - Fax:605-333-6804
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor