Provider Demographics
NPI:1215540372
Name:MILLETT, KIMBERLY S (MSWI)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MILLETT
Suffix:
Gender:F
Credentials:MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 N 1200 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2236
Mailing Address - Country:US
Mailing Address - Phone:801-380-1088
Mailing Address - Fax:
Practice Address - Street 1:879 S OREM BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5030
Practice Address - Country:US
Practice Address - Phone:801-802-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health