Provider Demographics
NPI:1740290311
Name:THORPE, KIMBERLY CAMILLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CAMILLE
Last Name:THORPE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BRACEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:MI
Mailing Address - Zip Code:49074
Mailing Address - Country:US
Mailing Address - Phone:269-567-9409
Mailing Address - Fax:269-329-4077
Practice Address - Street 1:615 W LOVELL ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4615
Practice Address - Country:US
Practice Address - Phone:248-431-1371
Practice Address - Fax:269-200-3088
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801070137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008967660OtherBCBSM
MIP22850001Medicare ID - Type Unspecified