Provider Demographics
NPI:1811395577
Name:TINSLEY, KIMBERLY RAE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:TINSLEY
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 1:1120 NOWITA PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3521
Mailing Address - Country:US
Mailing Address - Phone:213-488-9559
Mailing Address - Fax:213-270-9060
Practice Address - Street 1:1120 NOWITA PL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3521
Practice Address - Country:US
Practice Address - Phone:213-488-9559
Practice Address - Fax:213-270-9060
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health