Provider Demographics
NPI:1982039426
Name:KIMPTON HEALD, CARRIE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:KIMPTON HEALD
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 1:15615 ALTON PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7306
Mailing Address - Country:US
Mailing Address - Phone:319-538-8782
Mailing Address - Fax:855-779-3627
Practice Address - Street 1:15615 ALTON PKWY STE 230
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:319-538-8782
Practice Address - Fax:855-779-3627
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA000613OtherHEALTH SERVICE PROVIDER
IA0001247OtherIOWA PSYCHOLOGY LICENSE