Provider Demographics
NPI:1760241574
Name:BARR, KIMBERLY ROSE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROSE
Last Name:BARR
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 1:1905 ROBINSON ST APT C
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1958
Mailing Address - Country:US
Mailing Address - Phone:310-940-1819
Mailing Address - Fax:
Practice Address - Street 1:23332 HAWTHORNE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4457
Practice Address - Country:US
Practice Address - Phone:213-262-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health