Provider Demographics
NPI:1396406211
Name:KIMES, KARISSA (LAMFT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:KIMES
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N LAKEWOOD DR STE 225
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2473
Mailing Address - Country:US
Mailing Address - Phone:208-699-3667
Mailing Address - Fax:
Practice Address - Street 1:1042 W MILL AVE STE 103
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2489
Practice Address - Country:US
Practice Address - Phone:208-699-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-7786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLAMFT-7786OtherSTATE LICENSURE BOARD