Healthcare Provider Details

I. General information

NPI: 1588722870
Provider Name (Legal Business Name): KIRBY MCMAHON RICHARDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SW ROCK CREEK DR
STEVENSON WA
98648-4418
US

IV. Provider business mailing address

PO BOX 1492
STEVENSON WA
98648-1492
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-5452
  • Fax: 541-296-4792
Mailing address:
  • Phone: 509-427-3850
  • Fax: 509-427-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00009633
License Number StateWA

VII. Legacy identifiers

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

# 1
Identifier2046279
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: