Provider Demographics
NPI:1174654925
Name:EGEL, KIM ANN (MFT)
Entity Type:Individual
Prefix:MISS
First Name:KIM
Middle Name:ANN
Last Name:EGEL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N RIOS AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1246
Mailing Address - Country:US
Mailing Address - Phone:760-274-4649
Mailing Address - Fax:
Practice Address - Street 1:2047 SAN ELIJO AVE
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1726
Practice Address - Country:US
Practice Address - Phone:760-274-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health