Provider Demographics
NPI:1609286095
Name:KIMBERLY D DELANEY, APRN, PSYD, LLC
Entity Type:Organization
Organization Name:KIMBERLY D DELANEY, APRN, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP PSYD
Authorized Official - Phone:541-382-3002
Mailing Address - Street 1:255 SW BLUFF DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3220
Mailing Address - Country:US
Mailing Address - Phone:541-382-3002
Mailing Address - Fax:888-972-6509
Practice Address - Street 1:255 SW BLUFF DR STE 220
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3220
Practice Address - Country:US
Practice Address - Phone:541-382-3002
Practice Address - Fax:888-972-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI794261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health