Provider Demographics
NPI:1447801824
Name:VAN GILS, KIMBERLY KLEINMAN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KLEINMAN
Last Name:VAN GILS
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 1:2480 RED CLIFFS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5457
Mailing Address - Country:US
Mailing Address - Phone:435-673-6446
Mailing Address - Fax:
Practice Address - Street 1:2480 RED CLIFFS DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5457
Practice Address - Country:US
Practice Address - Phone:435-673-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty