Provider Demographics
NPI:1083080170
Name:SWEET, KIMBERLEY (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:SWEET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 EAST ALICE STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1912
Mailing Address - Country:US
Mailing Address - Phone:208-785-5874
Mailing Address - Fax:
Practice Address - Street 1:720 EAST ALICE STREET
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1912
Practice Address - Country:US
Practice Address - Phone:208-785-5874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5940101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor