Provider Demographics
NPI:1134317373
Name:KINO, KIMBERLY JUNE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JUNE
Last Name:KINO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E NORTHERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3972
Mailing Address - Country:US
Mailing Address - Phone:480-650-8883
Mailing Address - Fax:
Practice Address - Street 1:1825 E NORTHERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3972
Practice Address - Country:US
Practice Address - Phone:480-650-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health