Provider Demographics
NPI:1629755509
Name:LAST, KIMBERLY COPE (CPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:COPE
Last Name:LAST
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 WYNDHAM PL
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5382
Mailing Address - Country:US
Mailing Address - Phone:916-220-5592
Mailing Address - Fax:
Practice Address - Street 1:1540 WYNDHAM PL
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5382
Practice Address - Country:US
Practice Address - Phone:916-220-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health