Provider Demographics
NPI:1942714704
Name:NEVILLE, KIMBERLY DAYANI (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAYANI
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:NEVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8900 STATE LINE RD STE 357
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1983
Mailing Address - Country:US
Mailing Address - Phone:913-221-4397
Mailing Address - Fax:
Practice Address - Street 1:8900 STATE LINE RD STE 357
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1983
Practice Address - Country:US
Practice Address - Phone:913-221-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health