Provider Demographics
NPI:1609008077
Name:GRIGALIUNAS, KIMBERLY ANN (RC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GRIGALIUNAS
Suffix:
Gender:F
Credentials:RC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:BUNTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 NW 1ST STEET
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0000
Mailing Address - Country:US
Mailing Address - Phone:360-678-5555
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:105 NW FIRST STREET
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-0000
Practice Address - Country:US
Practice Address - Phone:360-678-5555
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60103606101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor