Provider Demographics
NPI:1073872206
Name:MCCLANNAHAN, KIMBERLY DEANNA (LPC, ATR-BC, RPT-S,)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DEANNA
Last Name:MCCLANNAHAN
Suffix:
Gender:F
Credentials:LPC, ATR-BC, RPT-S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 SUNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-4225
Mailing Address - Country:US
Mailing Address - Phone:678-522-5227
Mailing Address - Fax:
Practice Address - Street 1:9226 SUNSTONE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-4225
Practice Address - Country:US
Practice Address - Phone:678-522-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RPT-S-S1805101YM0800X
COLPC0011396101YP2500X
2080C0008X
12-136221700000X
GALPC006713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist