Provider Demographics
NPI:1821781493
Name:KYLE F RICHARDS PC
Entity Type:Organization
Organization Name:KYLE F RICHARDS PC
Other - Org Name:RICHARDS COUNSELING & CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LPC-MH
Authorized Official - Phone:712-540-4090
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 1:2098 GLENN ELLEN RD
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8078
Practice Address - Country:US
Practice Address - Phone:712-540-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC-MH30835OtherSD LPC-MH LICENSE
IA092334OtherIA LMHC LICENSE