Provider Demographics
NPI:1326253600
Name:PICKLESIMER, D KRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:D
Middle Name:KRIS
Last Name:PICKLESIMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:
Other - Last Name:PICKELSIMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:141 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-384-0978
Mailing Address - Fax:925-283-6841
Practice Address - Street 1:901 MORAGA RD
Practice Address - Street 2:SUITE D
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:925-283-6840
Practice Address - Fax:925-283-6840
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical