CLYDE A RICHARDSON (NPI# 1275709826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275709826 |
| Entity Type | Individual |
| Full Name | CLYDE A RICHARDSON |
| Credential | M DIV CAC-R |
| Practice Address |
3210 Eagle Run Dr Suite 200 Grand Rapids MI 49525 |
| Practice Telephone | 6169571200 |
| Practice Fax Number | 6169571297 |
| Mailing Telephone | 6169571200 |
| Mailing Fax Number | 6169571297 |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2009-06-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
6802067415 | MI | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
6802067415 | MI | Behavioral Health & Social Service Providers |
| N | 101YP1600X |
Counselor Specialization: Pastoral |
6802067415 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NONE | NONE | 01 |
| Street Address |
3210 EAGLE RUN DR SUITE 200 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952377566 | Bruce Henry Baker | Family Medicine | 3210 Eagle Run Dr, Suite 200, Grand Rapids, MI 49525 | 2006-02-23 |
| 1437324506 | Michael K. Kivinen | Psychologist | 3210 Eagle Run Dr, Suite 200, Grand Rapids, MI 49525 | 2008-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053928507 | Therapy With Nicole Pllc | Community/Behavioral Health | 4867 E. Beltline Ave. Ne, Building #1 Lower Level, Grand Rapids, MI 49525 | 2020-09-29 |
| 1184242760 | Christian Healthcare Specialists, Inc. | Obstetrics & Gynecology | 3322 Beltline Court Ne, Suite 1, Grand Rapids, MI 49525 | 2020-07-09 |
| 1174154645 | Amy Vanderslik | Case Manager/Care Coordinator | 3310 Eaglecrest Park Dr. Ne, Suite 100, Grand Rapids, MI 49525 | 2020-02-03 |
| 1477195246 | Epic Discoveries LLC | Counselor | 4867 E. Beltline Ave Ne, Grand Rapids, MI 49525 | 2019-10-14 |
| 1598228959 | Kim Scherencel Lmsw Counseling | Social Worker | 3280 Beltline Ne, Grand Rapids, MI 49525 | 2019-04-11 |
| 1821558958 | Mindful Trajectories | Social Worker | 3280 Beltlne Ct Ne, Grand Rapids, MI 49525 | 2019-03-24 |
| 1104380518 | Julianne Lettinga, Ma Lpc Counseling | Counselor | 3280 East Beltline Ct Ne, Grand Rapids, MI 49525 | 2019-01-30 |
| 1396227229 | Christopher Scot Doucette | Social Worker | 2064 Airway St Ne, Grand Rapids, MI 49525 | 2018-09-06 |
| 1568976017 | Amy K. Deyoung, Dds, Ms, PC Pediatric Dentistry | Dentist | 3297 Eagle Run Dr. Ne, Grand Rapids, MI 49525 | 2017-11-20 |
| 1407389604 | Kelly Jo Crabb | Social Worker | 4829 E Beltline Ave Ne Ste 100, Grand Rapids, MI 49525 | 2017-04-05 |
| Find all providers in zip 49525 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891302717 | Paige J Welch | Counselor | 1509 Diamond Ave Ne, Grand Rapids, MI 49505-5217 | 2020-09-24 |
| 1588277040 | Gregory Dean Retzlaff | Counselor | 2043 Rowe Ave Ne, Grand Rapids, MI 49505-4238 | 2020-08-25 |
| 1699392555 | Duane Stanley Helmer | Counselor | First Call for Help of Itasca County, 1707 Nw 4th Street Suite B, Grand Rapids, MN 55744 | 2020-06-26 |
| 1649779927 | Larry Mitchell | Counselor | 1960 Millbrook St Se, Grand Rapids, MI 49508-2636 | 2018-02-01 |
| 1235657388 | Courtney Albin | Counselor | 2504 Ardmore St Se Ste 202b, Grand Rapids, MI 49506-4901 | 2017-09-08 |
| 1649712001 | Alexander C Meyer | Counselor | 1200 S Pokegama Ave Ste 160, Grand Rapids, MN 55744-4296 | 2016-11-15 |
| 1871048934 | Nicole Nutt | Counselor | 32 Winter Ave Sw Apt 228, Grand Rapids, MI 49504-6488 | 2016-08-18 |
| 1306247564 | Krystal Strotbaum | Counselor | 5242 Plainfield Ave Ne Ste E, Grand Rapids, MI 49525-1084 | 2014-09-08 |
| 1710390372 | Laura Meeker Wicksall | Counselor | 1430 Robinson Rd Se Ste 206, Grand Rapids, MI 49506-1723 | 2014-06-11 |
| 1023358314 | Carole Lynn Walters | Counselor | 959 Wealthy St Se, Grand Rapids, MI 49506-2519 | 2013-02-22 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49525 |
Please comment or provide details below to improve the information on CLYDE A RICHARDSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.