Provider Demographics
NPI:1518689561
Name:COURSEY, KIMBERLY (RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:COURSEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:GOMEZ
Other - Last Name:CAYANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-1058 KEKUILANI LOOP APT 205
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2725
Mailing Address - Country:US
Mailing Address - Phone:415-590-9070
Mailing Address - Fax:
Practice Address - Street 1:94-428 MOKUOLA ST STE 214A
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3396
Practice Address - Country:US
Practice Address - Phone:808-944-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician