Provider Demographics
NPI:1780037283
Name:GROCEMAN, KYMBERLY A (LMHC)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:A
Last Name:GROCEMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 COMMODORE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9667
Mailing Address - Country:US
Mailing Address - Phone:219-928-6312
Mailing Address - Fax:
Practice Address - Street 1:902 COMMODORE COURT
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9667
Practice Address - Country:US
Practice Address - Phone:219-928-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002848A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health