Provider Demographics
NPI:1699100669
Name:RICHMOND, KELLY (MSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1008
Mailing Address - Country:US
Mailing Address - Phone:989-912-6000
Mailing Address - Fax:989-872-5376
Practice Address - Street 1:4675 HILL ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1008
Practice Address - Country:US
Practice Address - Phone:989-912-6000
Practice Address - Fax:989-872-5376
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020751751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical