Provider Demographics
NPI:1821321084
Name:CAOUETTE, KIMBERLY (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CAOUETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 168007
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-8007
Mailing Address - Country:US
Mailing Address - Phone:469-735-4545
Mailing Address - Fax:469-735-4640
Practice Address - Street 1:4701 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4900
Practice Address - Country:US
Practice Address - Phone:602-543-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical