Individual
KIMBLE L RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5756
Mailing address
6626 E 75TH STREET, STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7561
(317) 355-6096
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39000004A
IN
1041C0700X
Clinical Social Worker
Primary
34002814A
IN
106H00000X
Marriage & Family Therapist
35000369A
IN
Other
Enumeration date
12/07/2005
Last updated
03/12/2014
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