Provider Demographics
NPI:1336930429
Name:RICHARDS, KAMRYN SCOTT (NONE)
Entity type:Individual
Prefix:MS
First Name:KAMRYN
Middle Name:SCOTT
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:MS
Other - First Name:KAMRYN
Other - Middle Name:SCOTT
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NONE
Mailing Address - Street 1:833 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1726
Mailing Address - Country:US
Mailing Address - Phone:313-204-7656
Mailing Address - Fax:313-204-7656
Practice Address - Street 1:833 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1726
Practice Address - Country:US
Practice Address - Phone:313-204-7656
Practice Address - Fax:313-204-7656
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician