Provider Demographics
NPI:1417496092
Name:VENEMA, KIMBERLY K (MA, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:VENEMA
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 170TH AVE
Mailing Address - Street 2:
Mailing Address - City:HERSEY
Mailing Address - State:MI
Mailing Address - Zip Code:49639-8785
Mailing Address - Country:US
Mailing Address - Phone:231-832-7283
Mailing Address - Fax:
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional