Provider Demographics
NPI:1609122365
Name:KOESSEL, KIMBERLY CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:KOESSEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E. CHEYENNE MTN BLVD, STE C
Mailing Address - Street 2:#123
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-349-5772
Mailing Address - Fax:719-349-5774
Practice Address - Street 1:5350 TOMAH DR STE 1100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-466-6854
Practice Address - Fax:719-213-2459
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019072103T00000X
COPSY.0004839103TC0700X, 103TC1900X, 103T00000X
103T00000X
WAPY60277408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling