Provider Demographics
NPI:1427217421
Name:GAINES, KIMBERLY ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GAINES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28039 SCOTT ROAD
Mailing Address - Street 2:SUITE D246
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:951-821-0557
Mailing Address - Fax:951-672-1015
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS ROAD
Practice Address - Street 2:SUITE D160
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-821-0557
Practice Address - Fax:951-672-1015
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist