Provider Demographics
NPI:1124550454
Name:KIM, JUHEE
Entity Type:Individual
Prefix:
First Name:JUHEE
Middle Name:
Last Name:KIM
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 1:10727 DOMAIN DR APT 176
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5044
Mailing Address - Country:US
Mailing Address - Phone:773-988-8793
Mailing Address - Fax:
Practice Address - Street 1:10727 DOMAIN DR APT 176
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5044
Practice Address - Country:US
Practice Address - Phone:773-988-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002550101YP2500X
IL180011889101YP2500X
TX88550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional