Provider Demographics
NPI:1326056342
Name:CORNISH, KIMBERLY A (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:CORNISH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1850 OLYMPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2161
Mailing Address - Country:US
Mailing Address - Phone:863-595-0167
Mailing Address - Fax:863-837-9399
Practice Address - Street 1:1850 OLYMPIAN WAY
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2161
Practice Address - Country:US
Practice Address - Phone:863-595-0167
Practice Address - Fax:863-837-9399
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL760079800Medicaid