Provider Demographics
NPI:1336587724
Name:LYCAN, KIMBERLY (LMHC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LYCAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SCHEIDEGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 854
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-205-5559
Mailing Address - Fax:509-292-4155
Practice Address - Street 1:639 CULLUM AVE
Practice Address - Street 2:#854
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-205-5559
Practice Address - Fax:509-292-4155
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60662430101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health