Provider Demographics
NPI:1316202427
Name:METRO, KIMBERLY K
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:METRO
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 1:7519 BEECHWOOD CENTRE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7891
Mailing Address - Country:US
Mailing Address - Phone:317-272-8138
Mailing Address - Fax:
Practice Address - Street 1:7519 BEECHWOOD CENTRE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7891
Practice Address - Country:US
Practice Address - Phone:317-272-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291988101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor