Provider Demographics
NPI:1427201383
Name:GRANDE, KIMBERLY S (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:GRANDE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N. CR 300 WEST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135
Mailing Address - Country:US
Mailing Address - Phone:702-217-3978
Mailing Address - Fax:
Practice Address - Street 1:308 MEDIC WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-653-2669
Practice Address - Fax:765-653-8671
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001691A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist