Provider Demographics
NPI:1710108907
Name:HEMINGWAY, KIM A
Entity Type:Individual
Prefix:MISS
First Name:KIM
Middle Name:A
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1562
Mailing Address - Country:US
Mailing Address - Phone:928-773-8120
Mailing Address - Fax:928-773-8123
Practice Address - Street 1:400 W ELM AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1562
Practice Address - Country:US
Practice Address - Phone:928-773-8120
Practice Address - Fax:928-773-8123
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool