Provider Demographics
NPI:1013046002
Name:STREET, KIMBERLY ANN (LPC-MHSP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:STREET
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-4900
Mailing Address - Country:US
Mailing Address - Phone:615-797-3882
Mailing Address - Fax:
Practice Address - Street 1:1440 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2220
Practice Address - Country:US
Practice Address - Phone:615-740-1114
Practice Address - Fax:615-740-1114
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health