Provider Demographics
NPI:1376988287
Name:KIM, JOYCE (MA)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 ALTA DR STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4165
Mailing Address - Country:US
Mailing Address - Phone:702-474-6450
Mailing Address - Fax:702-474-6463
Practice Address - Street 1:1640 ALTA DR STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4165
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:702-474-6463
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02071-I101YA0400X
CAIMF73208106H00000X
NVMI0857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740728716Medicaid