Provider Demographics
NPI:1861834343
Name:KIMMEL, BETH JOY (BA,CDF, SST)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:JOY
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:BA,CDF, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1948
Mailing Address - Country:US
Mailing Address - Phone:248-760-4267
Mailing Address - Fax:
Practice Address - Street 1:3961 MORGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1948
Practice Address - Country:US
Practice Address - Phone:248-760-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management