Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | R-4963 | OR |
Y | 101YP2500X | Professional Counselor | C5608 | OR |
NPI | 1003326109 |
---|---|
Provider Name | Kimberly M Richards |
First Address | Bend, OR 97701-7752 |
Second Address | La Pine, OR 97739-9871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2017 |
Last Update Date | 05/03/2020 |