Provider Demographics
NPI:1801916317
Name:RICHARDS, KURT L (LMSW)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N. HADLEY
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462
Mailing Address - Country:US
Mailing Address - Phone:810-335-1313
Mailing Address - Fax:
Practice Address - Street 1:36250 DEQUINDRE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7143
Practice Address - Country:US
Practice Address - Phone:586-795-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081489104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker