Provider Demographics
NPI:1376933127
Name:WASHAM, KIMBERLY JEAN (MA, LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:WASHAM
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7526 E. 82ND ST. SUITE 150
Mailing Address - Street 2:FAMILY COUNSELING ASSOCIATES
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1492
Mailing Address - Country:US
Mailing Address - Phone:317-585-1060
Mailing Address - Fax:317-585-9811
Practice Address - Street 1:7526 E. 82ND ST. SUITE 150
Practice Address - Street 2:FAMILY COUNSELING ASSOCIATES
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1492
Practice Address - Country:US
Practice Address - Phone:317-585-1060
Practice Address - Fax:317-585-9811
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000061A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health