Provider Demographics
NPI:1801185715
Name:STURM, KIMBERLY TATIANA (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TATIANA
Last Name:STURM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 HAMNER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3630
Mailing Address - Country:US
Mailing Address - Phone:951-324-4644
Mailing Address - Fax:888-859-0638
Practice Address - Street 1:2741 HAMNER AVE STE 202
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3630
Practice Address - Country:US
Practice Address - Phone:951-324-4644
Practice Address - Fax:888-859-0638
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist