Provider Demographics
NPI:1326131095
Name:FREY, KIM P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:P
Last Name:FREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:P
Other - Last Name:TIMMRECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2610 GLENBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3118
Mailing Address - Country:US
Mailing Address - Phone:760-920-2868
Mailing Address - Fax:760-873-3277
Practice Address - Street 1:686 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3315
Practice Address - Country:US
Practice Address - Phone:760-920-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS208581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical