Provider Demographics
NPI:1821360793
Name:KIMBLE, MICHELE ELAINE (MED,LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELAINE
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:MED,LMHC
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 1882
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-1882
Mailing Address - Country:US
Mailing Address - Phone:206-567-0076
Mailing Address - Fax:
Practice Address - Street 1:9250 45TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2633
Practice Address - Country:US
Practice Address - Phone:206-567-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005349101YM0800X
WALH 00005349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health