Provider Demographics
NPI:1710183561
Name:TUNSTALL, KIM A (CCAPPS-AII060060718)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:A
Last Name:TUNSTALL
Suffix:
Gender:F
Credentials:CCAPPS-AII060060718
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADAAC
Mailing Address - Street 1:11776 MARIPOSA RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1622
Mailing Address - Country:US
Mailing Address - Phone:760-956-2462
Mailing Address - Fax:760-956-7542
Practice Address - Street 1:11776 MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1622
Practice Address - Country:US
Practice Address - Phone:760-956-2462
Practice Address - Fax:760-956-7542
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XMedicaid