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NPI Code Detail

MEDICARE: KIMBERLY RAYE RICHARDSON LLP, LBA, BCBA

MEDICARE: KIMBERLY RAYE RICHARDSON LLP, LBA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6362008876MI
2103K00000XBehavior Analyst7401001211MI

General Provider Information

NPI Number : 1902362346
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY RAYE RICHARDSON LLP, LBA, BCBA
Provider Business Mailing Address
First Line : 102 W WASHINGTON ST STE 106
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4350
Country : US
Telephone Number : 906-228-8881
Fax Number : 906-228-4549
Provider Business Practice Location Address
First Line : 102 W WASHINGTON ST STE 106
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4350
Country : US
Telephone Number : 906-228-8881
Fax Number : 906-228-4549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2019
Last Update Date : 03/02/2026

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