Provider Demographics
NPI:1154824266
Name:COUNSEL WITH KIM LLC
Entity Type:Organization
Organization Name:COUNSEL WITH KIM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRULAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-899-9069
Mailing Address - Street 1:618 EAGLE RUN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-5634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1543 LAKELAND HILLS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3246
Practice Address - Country:US
Practice Address - Phone:863-648-9749
Practice Address - Fax:863-648-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13783251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health