Provider Demographics
NPI:1083731848
Name:POUV, KIM M
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:POUV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 MAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9422
Mailing Address - Country:US
Mailing Address - Phone:209-869-6613
Mailing Address - Fax:
Practice Address - Street 1:5433 MAYBERRY CT
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9422
Practice Address - Country:US
Practice Address - Phone:209-869-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)