Provider Demographics
NPI:1003183427
Name:DOYLE, KIMBERLEY J (CDP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:J
Last Name:DOYLE
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 E OLD SCHOOL ROAD
Mailing Address - Street 2:PO BOX 540
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040-0540
Mailing Address - Country:US
Mailing Address - Phone:509-258-7502
Mailing Address - Fax:509-258-7029
Practice Address - Street 1:6228 E OLD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-258-7502
Practice Address - Fax:509-258-7029
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005177101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1467644294Medicaid