Provider Demographics
NPI:1437416633
Name:CZEMERES, KIM LEIGH ANNE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LEIGH ANNE
Last Name:CZEMERES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24475 AVENIDA DE MARCIA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4023
Mailing Address - Country:US
Mailing Address - Phone:714-694-1979
Mailing Address - Fax:
Practice Address - Street 1:3 POINTE DR
Practice Address - Street 2:SUITE #305
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-7622
Practice Address - Country:US
Practice Address - Phone:714-318-1848
Practice Address - Fax:714-256-9013
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC 00233101YM0800X
CAMFC 45130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health