Provider Demographics
NPI:1063903508
Name:RICHARDS, IESHA RENEE (LPC, LMHC, MAC, CEAP)
Entity type:Individual
Prefix:
First Name:IESHA
Middle Name:RENEE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LPC, LMHC, MAC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8149 NEW LA GRANGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4689
Mailing Address - Country:US
Mailing Address - Phone:502-533-5288
Mailing Address - Fax:502-688-6149
Practice Address - Street 1:6408 PASSIONFLOWER DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-6301
Practice Address - Country:US
Practice Address - Phone:951-790-7780
Practice Address - Fax:502-964-7771
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15020101YM0800X
HI589101YM0800X
DCPRC14480101YP2500X
KY247831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health