Provider Demographics
NPI:1831295864
Name:ARREDONDO, KIM MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:ARREDONDO
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 1:704 E 29TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-4898
Mailing Address - Country:US
Mailing Address - Phone:979-574-8801
Mailing Address - Fax:979-775-9079
Practice Address - Street 1:704 E 29TH ST STE B
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4898
Practice Address - Country:US
Practice Address - Phone:979-574-8801
Practice Address - Fax:979-775-9079
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32759103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist