Provider Demographics
NPI:1598774325
Name:ANDERSON, KIMBERLEE ANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:KIMBERLEE
Other - Middle Name:ANN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:3135 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-3253
Mailing Address - Country:US
Mailing Address - Phone:618-538-5728
Mailing Address - Fax:618-394-5909
Practice Address - Street 1:8601 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-1719
Practice Address - Country:US
Practice Address - Phone:618-394-5900
Practice Address - Fax:618-394-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional