Provider Demographics
NPI:1083070437
Name:ENDTER, KIMI L (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMI
Middle Name:L
Last Name:ENDTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-1190
Mailing Address - Country:US
Mailing Address - Phone:435-319-0039
Mailing Address - Fax:
Practice Address - Street 1:437 S BLUFF ST STE 302
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3591
Practice Address - Country:US
Practice Address - Phone:435-634-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7026701-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical