Provider Demographics
NPI:1578885661
Name:KIMBER, GEORGIA ANN (FMT)
Entity Type:Individual
Prefix:MISS
First Name:GEORGIA
Middle Name:ANN
Last Name:KIMBER
Suffix:
Gender:F
Credentials:FMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SOUTH 500 EAST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2527
Mailing Address - Country:US
Mailing Address - Phone:801-216-8000
Mailing Address - Fax:
Practice Address - Street 1:433 S 500 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2527
Practice Address - Country:US
Practice Address - Phone:801-216-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52612143902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist