Provider Demographics
NPI:1417124728
Name:LINDHOLM, KIMBERLI JAYNE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLI
Middle Name:JAYNE
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KIMBERLI
Other - Middle Name:JAYNE
Other - Last Name:MCMURCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-783-8129
Mailing Address - Fax:
Practice Address - Street 1:120 VISTA WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-783-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health