Provider Demographics
NPI:1043235708
Name:KIMERY, H. JO (RN, LCPC)
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:JO
Last Name:KIMERY
Suffix:
Gender:F
Credentials:RN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 S RUSSELL ST
Mailing Address - Street 2:SUITE 120-8
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8574
Mailing Address - Country:US
Mailing Address - Phone:406-542-7027
Mailing Address - Fax:406-543-0602
Practice Address - Street 1:3700 S RUSSELL ST
Practice Address - Street 2:SUITE 120-8
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8574
Practice Address - Country:US
Practice Address - Phone:406-542-7027
Practice Address - Fax:406-543-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT740223OtherBCBS
MT252909Medicaid