Provider Demographics
NPI:1003692237
Name:BAILEY, KIMBERLY A (AMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 EARNSCLIFF PL APT 42
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4155
Mailing Address - Country:US
Mailing Address - Phone:619-379-8684
Mailing Address - Fax:
Practice Address - Street 1:4455 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4379
Practice Address - Country:US
Practice Address - Phone:619-379-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist