Provider Demographics
NPI:1508976291
Name:WINBERY, KIM ELIZABETH (MAHS, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELIZABETH
Last Name:WINBERY
Suffix:
Gender:F
Credentials:MAHS, LPC, LCPC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ELIZABETH
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 E MEADOW ST STE 6
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5357
Mailing Address - Country:US
Mailing Address - Phone:702-600-1431
Mailing Address - Fax:
Practice Address - Street 1:26 E MEADOW ST STE 6
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5357
Practice Address - Country:US
Practice Address - Phone:479-431-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04459101YP2500X
TX17995101YP2500X
NVCP0007101YP2500X
ARP1309095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17995OtherLPC LICENSE #
GA212453OtherNCC CERTIFICATION #
NVCP0007OtherLCPC
AR#P1309095OtherLPC
GA004459OtherLPC LICENSE #
GA212453OtherNCC CERTIFICATION #
TX17995OtherLPC LICENSE #