Healthcare Provider Details

I. General information

NPI: 1477025047
Provider Name (Legal Business Name): LYCAN COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 CULLUM AVE STE 854
RICHLAND WA
99352
US

IV. Provider business mailing address

639 CULLUM AVE STE 854
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-205-5559
  • Fax: 509-292-4155
Mailing address:
  • Phone: 509-205-5559
  • Fax: 509-292-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY LYCAN
Title or Position: FOUNDER/OWNER
Credential: LMHC
Phone: 509-205-5559