Provider Demographics
NPI:1124231881
Name:KIMSEY, KATHERINE ANN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:KIMSEY
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 CHADBOURNE RD STE E
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9620
Mailing Address - Country:US
Mailing Address - Phone:707-425-9670
Mailing Address - Fax:
Practice Address - Street 1:470 CHADBOURNE RD STE E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9620
Practice Address - Country:US
Practice Address - Phone:707-425-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28024103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680235667OtherBUSINESS TAX ID NAME SALUATARY SPORTSCLUBS