Provider Demographics
NPI:1821555921
Name:SHEPHERD, KYMBERLY ANN (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:ANN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 128TH ST SW
Mailing Address - Street 2:E201
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204
Mailing Address - Country:US
Mailing Address - Phone:425-330-1395
Mailing Address - Fax:
Practice Address - Street 1:1011 128TH ST SW
Practice Address - Street 2:E201
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204
Practice Address - Country:US
Practice Address - Phone:425-330-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor