Provider Demographics
NPI:1962863928
Name:LORI KIMMERLY THERAPY AND COACHING PLLC
Entity Type:Organization
Organization Name:LORI KIMMERLY THERAPY AND COACHING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KIMMERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:253-347-2579
Mailing Address - Street 1:33507 9TH AVE S
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6397
Mailing Address - Country:US
Mailing Address - Phone:253-347-2579
Mailing Address - Fax:253-838-1439
Practice Address - Street 1:33507 9TH AVE S
Practice Address - Street 2:SUITE C-3
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6397
Practice Address - Country:US
Practice Address - Phone:253-347-2579
Practice Address - Fax:253-838-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60172540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty