Healthcare Provider Details

I. General information

NPI: 1821781493
Provider Name (Legal Business Name): KYLE F RICHARDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2098 GLENN ELLEN RD
SERGEANT BLUFF IA
51054-8078
US

IV. Provider business mailing address

2098 GLENN ELLEN RD
SERGEANT BLUFF IA
51054-8078
US

V. Phone/Fax

Practice location:
  • Phone: 712-540-4090
  • Fax:
Mailing address:
  • Phone: 712-540-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLPC-MH30835
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSD LPC-MH LICENSE
# 2
Identifier092334
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerIA LMHC LICENSE

VIII. Authorized Official

Name: KYLE F RICHARDS
Title or Position: OWNER
Credential: LMHC, LPC-MH
Phone: 712-540-4090