Provider Demographics
NPI:1083937361
Name:EMMETT-KINNARD, DAWN MARIE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:EMMETT-KINNARD
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 1:1921 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3036
Mailing Address - Country:US
Mailing Address - Phone:480-755-5553
Mailing Address - Fax:480-456-2964
Practice Address - Street 1:1921 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3036
Practice Address - Country:US
Practice Address - Phone:480-755-5553
Practice Address - Fax:480-456-2964
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ300123454OtherTREE OF LIFE INC