Provider Demographics
NPI:1114204021
Name:ROETS, KIMBERLY LOUISE (MFT-INTERN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOUISE
Last Name:ROETS
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BROOKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT-INTERN
Mailing Address - Street 1:9801 GAVIN STONE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8608
Mailing Address - Country:US
Mailing Address - Phone:775-453-3459
Mailing Address - Fax:
Practice Address - Street 1:9801 GAVIN STONE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8608
Practice Address - Country:US
Practice Address - Phone:775-453-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)