Provider Demographics
NPI:1639208796
Name:MEYER, KIMBERLY A (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8422
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-6422
Mailing Address - Country:US
Mailing Address - Phone:760-250-0867
Mailing Address - Fax:
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 209
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6788
Practice Address - Country:US
Practice Address - Phone:760-250-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT33606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-8160067OtherFEDERAL TAX ID