Provider Demographics
NPI:1063641447
Name:LIM, KATHRYNE (PSR)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:PSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 RODEO PARK DR W
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6351
Mailing Address - Country:US
Mailing Address - Phone:505-986-9633
Mailing Address - Fax:505-473-3038
Practice Address - Street 1:2960 RODEO PARK DR W
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6351
Practice Address - Country:US
Practice Address - Phone:505-986-9633
Practice Address - Fax:505-473-3038
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2020-10-08
Deactivation Date:2017-04-05
Deactivation Code:
Reactivation Date:2020-10-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst