Provider Demographics
NPI:1437144623
Name:KALAS, KIM ALLYSON (EDD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ALLYSON
Last Name:KALAS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N SAN FRANCISCO ST
Mailing Address - Street 2:STE. P
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3254
Mailing Address - Country:US
Mailing Address - Phone:928-774-6414
Mailing Address - Fax:928-527-8596
Practice Address - Street 1:914 N SAN FRANCISCO ST
Practice Address - Street 2:STE. P
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3254
Practice Address - Country:US
Practice Address - Phone:928-774-6414
Practice Address - Fax:928-527-8596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS#3409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74420Medicare ID - Type Unspecified