| Kim Richardson Therapy Llc | |
|
186 S River Ave Ste 7 Holland MI 49423-2848 | |
| (312) 882-5067 | |
| Not Available |
| Full Name | Kim Richardson Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 186 S River Ave Ste 7, Holland, Michigan |
| Authorized Official Name and Position | Kim Adrienne Richardson (LMSW, LPC) |
| Authorized Official Contact | 3128825067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim Richardson Therapy Llc Po Box 444 Saugatuck MI 49453-0444 Ph: (312) 882-5067 | Kim Richardson Therapy Llc 186 S River Ave Ste 7 Holland MI 49423-2848 Ph: (312) 882-5067 |
| NPI Number | 1104536382 |
|---|---|
| Provider Enumeration Date | 11/29/2022 |
| Last Update Date | 07/08/2023 |
| Certification Date | 07/08/2023 |
| Medicare PECOS PAC ID | 0648645010 |
|---|---|
| Medicare Enrollment ID | O20230417002823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104536382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kim Adrienne Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326305806 PECOS PAC ID: 1557736923 Enrollment ID: I20230417002867 |
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