Provider Demographics
NPI:1043701980
Name:PRICE, KIMBERLY MICAELA (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICAELA
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICAELA
Other - Last Name:CLOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 EAST AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1629
Mailing Address - Country:US
Mailing Address - Phone:530-519-1800
Mailing Address - Fax:
Practice Address - Street 1:1430 EAST AVE STE 4A
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1629
Practice Address - Country:US
Practice Address - Phone:530-519-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist