Provider Demographics
NPI:1689964041
Name:PEPELEA, KIMBERLI (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:
Last Name:PEPELEA
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-1610
Mailing Address - Country:US
Mailing Address - Phone:812-917-3186
Mailing Address - Fax:812-917-4260
Practice Address - Street 1:1537 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1610
Practice Address - Country:US
Practice Address - Phone:812-917-3186
Practice Address - Fax:812-917-4260
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340062371041C0700X
IN87001381A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000770392OtherANTHEM
IN000000770392OtherANTHEM