Provider Demographics
NPI:1043892995
Name:HOMENIUK, KIMBERLY NELSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:NELSON
Last Name:HOMENIUK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14329 GERONIMO
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-9698
Mailing Address - Country:US
Mailing Address - Phone:512-745-7598
Mailing Address - Fax:
Practice Address - Street 1:650 5TH ST STE 405
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1541
Practice Address - Country:US
Practice Address - Phone:415-231-5333
Practice Address - Fax:415-231-5332
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health