Provider Demographics
NPI:1407363690
Name:KIMBERLY B RASMUSSEN, PLLC
Entity Type:Organization
Organization Name:KIMBERLY B RASMUSSEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-243-9308
Mailing Address - Street 1:850 E CENTER ST STE F
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5737
Mailing Address - Country:US
Mailing Address - Phone:208-243-9308
Mailing Address - Fax:208-544-9574
Practice Address - Street 1:850 E CENTER ST STE F
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5737
Practice Address - Country:US
Practice Address - Phone:208-243-9308
Practice Address - Fax:208-544-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1740568658OtherTYPE I NPI